Provider Demographics
NPI:1851563787
Name:TAPIA GOMEZ, MARIO A (MD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:A
Last Name:TAPIA GOMEZ
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:PO BOX 531768
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553-1768
Mailing Address - Country:US
Mailing Address - Phone:956-389-6565
Mailing Address - Fax:956-389-6567
Practice Address - Street 1:2101 PEASE ST
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8307
Practice Address - Country:US
Practice Address - Phone:956-389-6565
Practice Address - Fax:956-389-6567
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN61694207R00000X
MO2016029312208M00000X
TXM9045208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist