Provider Demographics
NPI:1841789229
Name:GOMER, JEREMY VETHAN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:VETHAN
Last Name:GOMER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 COMMERCENTER E STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3443
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27403 YNEZ RD STE 108
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4619
Practice Address - Country:US
Practice Address - Phone:951-750-7888
Practice Address - Fax:951-750-7899
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA165223207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine