Provider Demographics
NPI:1972552388
Name:GOMEZ, ANNA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIA
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 W PARKER RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7901
Mailing Address - Country:US
Mailing Address - Phone:972-608-0200
Mailing Address - Fax:972-608-0617
Practice Address - Street 1:6130 W PARKER RD
Practice Address - Street 2:SUITE 400
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7901
Practice Address - Country:US
Practice Address - Phone:972-608-0200
Practice Address - Fax:972-608-0617
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4005208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034574602Medicaid
TX034574601Medicaid
TX034574602Medicaid