Provider Demographics
NPI:1134177066
Name:GOMEZ-CORTES, JOSE DEJESUS (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:DEJESUS
Last Name:GOMEZ-CORTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MADRID ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2283
Mailing Address - Country:US
Mailing Address - Phone:305-931-7190
Mailing Address - Fax:
Practice Address - Street 1:801 MADRID ST
Practice Address - Street 2:SUITE 210
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2283
Practice Address - Country:US
Practice Address - Phone:305-931-7190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050169207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02920Medicare PIN
FLU5668TMedicare PIN
FLU5668FMedicare PIN
FLD20807Medicare UPIN
FLU5668ZMedicare PIN
FL02920ZMedicare PIN
FLU5668MMedicare PIN