Provider Demographics
NPI:1013942325
Name:GOMEZ, WANEE G (MD)
Entity Type:Individual
Prefix:
First Name:WANEE
Middle Name:G
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WANEE
Other - Middle Name:G
Other - Last Name:LUDWIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2100 KANOELEHUA AVE
Mailing Address - Street 2:B-9
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-6500
Mailing Address - Country:US
Mailing Address - Phone:808-981-1700
Mailing Address - Fax:808-981-1701
Practice Address - Street 1:2100 KANOELEHUA AVE
Practice Address - Street 2:B-9
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-6500
Practice Address - Country:US
Practice Address - Phone:808-981-1700
Practice Address - Fax:808-981-1701
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD11067207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H13637Medicare UPIN
HIH52577Medicare ID - Type Unspecified