Provider Demographics
NPI:1760633036
Name:PERDON, MICHAEL ARDEN GOMEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL ARDEN
Middle Name:GOMEZ
Last Name:PERDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 FROSTWOOD DR
Mailing Address - Street 2:STE 1.100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2301
Mailing Address - Country:US
Mailing Address - Phone:713-338-4523
Mailing Address - Fax:
Practice Address - Street 1:6400 FANNIN ST
Practice Address - Street 2:STE 2015
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1521
Practice Address - Country:US
Practice Address - Phone:713-704-0669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10030999207R00000X
TXN5331207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX214993201Medicaid
TX8ED309OtherBCBS (MDACC)
TX214993202Medicaid
TX8CL154OtherBCBSTX
TXTXB105539Medicare PIN
TX8ED309OtherBCBS (MDACC)