Provider Demographics
NPI:1710178116
Name:GOMEZ, NARCISO LINO (MD)
Entity Type:Individual
Prefix:DR
First Name:NARCISO
Middle Name:LINO
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:320 S FLAMINGO RD STE 351
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1770
Mailing Address - Country:US
Mailing Address - Phone:954-369-5717
Mailing Address - Fax:954-827-0717
Practice Address - Street 1:3475 SHERIDAN ST STE 201
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3659
Practice Address - Country:US
Practice Address - Phone:954-369-5717
Practice Address - Fax:954-827-0717
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME98664208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115065000Medicaid