Provider Demographics
NPI:1255397089
Name:GOMEZ, FRANCISCO JAVIER (MD)
Entity type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:JAVIER
Last Name:GOMEZ
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 1:18550 US HIGHWAY 441
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-6751
Mailing Address - Country:US
Mailing Address - Phone:352-735-3755
Mailing Address - Fax:352-735-3151
Practice Address - Street 1:18550 US HIGHWAY 441
Practice Address - Street 2:SUITE A
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6751
Practice Address - Country:US
Practice Address - Phone:352-735-3755
Practice Address - Fax:352-735-3151
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-069762207R00000X, 207RI0200X
FLME 105557207R00000X
FLME105557207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01699200Medicaid
IN200317770Medicaid
KY64963705Medicaid
OH110233747OtherRAIL ROAD MEDICARE
OH2328289Medicaid
FLCS356ZMedicare PIN
KY64963705Medicaid
OHGO0887831Medicare PIN