Provider Demographics
NPI:1932110186
Name:GOMEZ, EDDUNIO (MD)
Entity Type:Individual
Prefix:MR
First Name:EDDUNIO
Middle Name:
Last Name: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 1:43 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4613
Mailing Address - Country:US
Mailing Address - Phone:305-242-1399
Mailing Address - Fax:305-242-9442
Practice Address - Street 1:43 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4613
Practice Address - Country:US
Practice Address - Phone:305-242-1399
Practice Address - Fax:305-242-9442
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34559208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039069100Medicaid
FL95381Medicare ID - Type Unspecified
FL039069100Medicaid