Provider Demographics
NPI:1972731024
Name:GOMEZ, RICARDO JR (MD)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:
Last Name:GOMEZ
Suffix:JR
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 1:12200 ACADEMY RD NE
Mailing Address - Street 2:APT # 213
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7245
Mailing Address - Country:US
Mailing Address - Phone:559-936-1151
Mailing Address - Fax:
Practice Address - Street 1:DEPT OF ANESTHESIA MSC 11 6120
Practice Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-2610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-28
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2013-0555207L00000X
NM207L00000X207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMMD2013-0555OtherNEW MEXICO MEDICAL LICENSE
NMCS00219185OtherNEW MEXICO PHARMACY BOARD