Provider Demographics
NPI:1710970199
Name:GOMEZ, JOHN IVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:IVAN
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:925 GESSNER RD STE 510
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2644
Mailing Address - Country:US
Mailing Address - Phone:832-530-4159
Mailing Address - Fax:713-467-6389
Practice Address - Street 1:18955 N MEMORIAL DR STE 77338
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4271
Practice Address - Country:US
Practice Address - Phone:832-530-4159
Practice Address - Fax:713-467-6389
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2089207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000034172Medicaid
DE1000034172Medicaid
I17496Medicare UPIN
TX8L7521Medicare PIN