Provider Demographics
NPI:1356951016
Name:GOMEZ, HAYDEN ROBERT (PA-S2)
Entity type:Individual
Prefix:
First Name:HAYDEN
Middle Name:ROBERT
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:PA-S2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-3111
Mailing Address - Country:US
Mailing Address - Phone:806-797-4985
Mailing Address - Fax:
Practice Address - Street 1:301 UTICA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-3111
Practice Address - Country:US
Practice Address - Phone:806-797-4985
Practice Address - Fax:806-792-8588
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15278363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant