Provider Demographics
NPI:1134168636
Name:GOMEZ, LUIS EMILIO SR (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:EMILIO
Last Name:GOMEZ
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:L.E.
Other - Middle Name:
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:219 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-2913
Mailing Address - Country:US
Mailing Address - Phone:410-708-7640
Mailing Address - Fax:410-819-5989
Practice Address - Street 1:7116 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-2904
Practice Address - Country:US
Practice Address - Phone:443-577-0277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD042421207P00000X
MDD0075451207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254014200Medicaid
FLG06573Medicare UPIN
FL41711Medicare ID - Type Unspecified