Provider Demographics
NPI:1215998885
Name:GAMEZ, RANDOLPH MARTIN (MD)
Entity type:Individual
Prefix:MR
First Name:RANDOLPH
Middle Name:MARTIN
Last Name:GAMEZ
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:305-500-2023
Mailing Address - Fax:305-500-2155
Practice Address - Street 1:917 SOUTH PORT AVENUE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405
Practice Address - Country:US
Practice Address - Phone:361-887-0584
Practice Address - Fax:361-887-0586
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2021-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXG7647207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B22860Medicare UPIN