Provider Demographics
NPI:1841248499
Name:GOMER, ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:GOMER
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 1:13590 JOG RD
Mailing Address - Street 2:STE 4-5
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3807
Mailing Address - Country:US
Mailing Address - Phone:561-496-0833
Mailing Address - Fax:
Practice Address - Street 1:13590 JOG RD
Practice Address - Street 2:STE 4-5
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-3807
Practice Address - Country:US
Practice Address - Phone:561-496-0833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2022-10-20
Deactivation Date:2022-04-27
Deactivation Code:
Reactivation Date:2022-10-20
Provider Licenses
StateLicense IDTaxonomies
FLME0062210207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21543OtherGROUP
FL17694YMedicare ID - Type Unspecified
FLE61128Medicare UPIN