Provider Demographics
NPI:1215474101
Name:GERHARD F GOMEZ MD LLC
Entity type:Organization
Organization Name:GERHARD F GOMEZ MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GERHARD
Authorized Official - Middle Name:FRANCOIS
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-824-8404
Mailing Address - Street 1:PO BOX 10261
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85064-0261
Mailing Address - Country:US
Mailing Address - Phone:602-824-8404
Mailing Address - Fax:602-899-6550
Practice Address - Street 1:2122 E HIGHLAND AVE STE 335
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4760
Practice Address - Country:US
Practice Address - Phone:602-824-8404
Practice Address - Fax:602-899-6550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ497912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty