Provider Demographics
NPI:1215044557
Name:GOMEZ, GILBERTO (MD)
Entity type:Individual
Prefix:
First Name:GILBERTO
Middle Name:
Last Name:GOMEZ
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 1:2325 PERSHING DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-3608
Mailing Address - Country:US
Mailing Address - Phone:915-590-5600
Mailing Address - Fax:915-590-7367
Practice Address - Street 1:2325 PERSHING DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-3608
Practice Address - Country:US
Practice Address - Phone:915-590-5600
Practice Address - Fax:915-590-7367
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9705208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8H0431OtherBC/BS OF TEXAS
TX165779301Medicaid
TXM0136077OtherDPS