Provider Demographics
NPI:1942615034
Name:OMAR A. GOMEZ, M.D.P.A.
Entity Type:Organization
Organization Name:OMAR A. GOMEZ, M.D.P.A.
Other - Org Name:KID CARE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-439-0303
Mailing Address - Street 1:590 FM 156 S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-3605
Mailing Address - Country:US
Mailing Address - Phone:817-439-0303
Mailing Address - Fax:817-847-1353
Practice Address - Street 1:590 FM 156 S
Practice Address - Street 2:SUITE 100
Practice Address - City:HASLET
Practice Address - State:TX
Practice Address - Zip Code:76052-3605
Practice Address - Country:US
Practice Address - Phone:817-439-0303
Practice Address - Fax:817-847-1353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty