Provider Demographics
NPI:1295956332
Name:DALYS F GOMEZ M D P A
Entity type:Organization
Organization Name:DALYS F GOMEZ M D P A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DALYS
Authorized Official - Middle Name:F
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-687-1222
Mailing Address - Street 1:3322 PRINCE GEORGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3930
Mailing Address - Country:US
Mailing Address - Phone:210-687-1222
Mailing Address - Fax:210-698-1110
Practice Address - Street 1:24165 W IH 10 STE 126
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1109
Practice Address - Country:US
Practice Address - Phone:210-687-1222
Practice Address - Fax:210-698-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2704207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611460Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TXH84092Medicare UPIN