Provider Demographics
NPI:1851983662
Name:JEREMY V GOMER MD PHD PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JEREMY V GOMER MD PHD PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:VIRTUE PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:VETHAN
Authorized Official - Last Name:GOMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-750-7888
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:909-533-0786
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty