Provider Demographics
NPI:1831156066
Name:GOMARA, ROBERTO ENRIQUE
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:ENRIQUE
Last Name:GOMARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 SW 60TH CT
Mailing Address - Street 2:SUITE #204
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4000
Mailing Address - Country:US
Mailing Address - Phone:305-661-6110
Mailing Address - Fax:305-662-5882
Practice Address - Street 1:3200 SW 60TH CT
Practice Address - Street 2:SUITE #204
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4000
Practice Address - Country:US
Practice Address - Phone:305-661-6110
Practice Address - Fax:305-662-5882
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QI0500X
FLME932202080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274283700Medicaid