Provider Demographics
NPI:1952487688
Name:GOMEZ, MANUEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:A
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 1:500 VONDERBURG DR STE 102
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5968
Mailing Address - Country:US
Mailing Address - Phone:813-681-5658
Mailing Address - Fax:813-681-5250
Practice Address - Street 1:500 VONDERBURG DR STE 102E
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5968
Practice Address - Country:US
Practice Address - Phone:813-681-5658
Practice Address - Fax:813-681-5250
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6724259OtherCIGNA PROVIDER NUMBER
FL593400761OtherHUMANA MEDICARE PROVIDER NUMBER
FL593400761COtherHUMANA COMMERCIAL PROVIDER NUMBER
FL94435OtherBCBS PROVIDER NUMBER
FL364500OtherWELLCARE PROVIDER NUMBER
FL593400761COtherHUMANA COMMERCIAL PROVIDER NUMBER
FLK8643Medicare PIN