Provider Demographics
NPI:1023235579
Name:GOMEZ-MEADE, CARLOS (DO)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:GOMEZ-MEADE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W. BOISE CIRCLE, SUITE 400
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012
Mailing Address - Country:US
Mailing Address - Phone:918-307-0215
Mailing Address - Fax:918-250-7669
Practice Address - Street 1:800 W. BOISE CIRCLE, SUITE 400
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012
Practice Address - Country:US
Practice Address - Phone:918-307-0215
Practice Address - Fax:918-250-7669
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0829207ND0101X, 207N00000X, 207ND0101X
OK6596207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX302669201Medicaid
TXTXB155961Medicare PIN