Provider Demographics
NPI:1295072601
Name:GOMEZ ROBERTS, HUNTER AZDEL (MD)
Entity type:Individual
Prefix:DR
First Name:HUNTER
Middle Name:AZDEL
Last Name:GOMEZ ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HUNTER
Other - Middle Name:AZDEL
Other - Last Name:GOMEZ ROBERTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1301 ORLEANS ST 313E
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-2968
Mailing Address - Country:US
Mailing Address - Phone:646-629-9104
Mailing Address - Fax:
Practice Address - Street 1:818 ELLICOTT ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203
Practice Address - Country:US
Practice Address - Phone:716-323-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292965-1207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine