Provider Demographics
NPI:1336602556
Name:GOMATOS, ELIAS LEFTERIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:LEFTERIS
Last Name:GOMATOS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7726 LOUIS PASTEUR DRIVE, 1ST POD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2701
Mailing Address - Country:US
Mailing Address - Phone:210-575-3327
Mailing Address - Fax:210-575-7699
Practice Address - Street 1:7726 LOUIS PASTEUR DRIVE, 1ST POD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2701
Practice Address - Country:US
Practice Address - Phone:210-575-3327
Practice Address - Fax:210-575-7699
Is Sole Proprietor?:No
Enumeration Date:2019-04-14
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX3151213E00000X, 213ES0131X, 213ES0103X
FLPO4240213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery