Provider Demographics
NPI:1972589414
Name:GOMEZ DUARTE, CRISTOBAL (MD)
Entity Type:Individual
Prefix:
First Name:CRISTOBAL
Middle Name:
Last Name:GOMEZ DUARTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:690 CALLE CESAR GONZALEZ
Mailing Address - Street 2:APT PH307
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3913
Mailing Address - Country:US
Mailing Address - Phone:787-722-1717
Mailing Address - Fax:787-723-1595
Practice Address - Street 1:1449 AMERICO SALAS
Practice Address - Street 2:STE 103
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2104
Practice Address - Country:US
Practice Address - Phone:787-722-1717
Practice Address - Fax:787-723-1595
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2012-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR5846207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC84107Medicare UPIN
PR0097345Medicare PIN