Provider Demographics
NPI:1942418991
Name:GOMEZ, PABLO III (MD)
Entity Type:Individual
Prefix:DR
First Name:PABLO
Middle Name:
Last Name:GOMEZ
Suffix:III
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 1:615 E PRINCETON ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1456
Mailing Address - Country:US
Mailing Address - Phone:407-303-5781
Mailing Address - Fax:
Practice Address - Street 1:615 E PRINCETON ST
Practice Address - Street 2:SUITE 310
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1456
Practice Address - Country:US
Practice Address - Phone:407-303-5781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA239872390200000X
FLME1129902088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program