Provider Demographics
NPI:1891745147
Name:GOMEZ, REX L (MD)
Entity Type:Individual
Prefix:DR
First Name:REX
Middle Name:L
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1273 FLORIDA AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2485
Mailing Address - Country:US
Mailing Address - Phone:321-690-0002
Mailing Address - Fax:321-632-1358
Practice Address - Street 1:1273 FLORIDA AVE S
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2485
Practice Address - Country:US
Practice Address - Phone:321-690-0002
Practice Address - Fax:321-632-1358
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56227207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044214300Medicaid
FLE65204Medicare UPIN
FL044214300Medicaid