Provider Demographics
NPI:1831280965
Name:GOMEZ, MARIA R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:R
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4730 N HABANA AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7163
Mailing Address - Country:US
Mailing Address - Phone:813-549-2134
Mailing Address - Fax:813-864-4436
Practice Address - Street 1:4726 N HABANA AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7144
Practice Address - Country:US
Practice Address - Phone:813-873-2663
Practice Address - Fax:813-873-7001
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2017-02-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0043942207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045372200Medicaid
FL045372200Medicaid
E14703Medicare UPIN