Provider Demographics
NPI:1932299831
Name:GOMEZ, MARTIN (MD,)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:DR
Other - First Name:MARTIN
Other - Middle Name:
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD,
Mailing Address - Street 1:9202 ELAM RD
Mailing Address - Street 2:SUITE #110
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-4151
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2820 N BELT LINE RD STE 100
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-9388
Practice Address - Country:US
Practice Address - Phone:972-288-6189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0212208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics