Provider Demographics
NPI:1841255734
Name:GOMENDOZA, RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:GOMENDOZA
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 1:2090 S. OHIO ST.
Mailing Address - Street 2:SUITE 3W
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401
Mailing Address - Country:US
Mailing Address - Phone:785-309-2323
Mailing Address - Fax:785-309-2331
Practice Address - Street 1:2090 S. OHIO ST.
Practice Address - Street 2:SUITE 3W
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401
Practice Address - Country:US
Practice Address - Phone:785-309-2323
Practice Address - Fax:785-309-2331
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015033468207RE0101X
KS0428513207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200269770DMedicaid
MOB94000022Medicare PIN