Provider Demographics
NPI:1194489963
Name:GOMEZ, ROLANDO GONZALES JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:ROLANDO
Middle Name:GONZALES
Last Name:GOMEZ
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2800 S TEXAS AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5361
Mailing Address - Country:US
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Mailing Address - Fax:
Practice Address - Street 1:2801 FRANCISCAN DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2544
Practice Address - Country:US
Practice Address - Phone:979-776-2537
Practice Address - Fax:979-776-2526
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2022-08-30
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Provider Licenses
StateLicense IDTaxonomies
TXPA15061363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1194489963Medicaid