Provider Demographics
NPI:1316918485
Name:GOMEZ, COSME A (MD)
Entity type:Individual
Prefix:
First Name:COSME
Middle Name:A
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7600 SW 87TH AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3601
Mailing Address - Country:US
Mailing Address - Phone:305-275-5525
Mailing Address - Fax:305-275-0662
Practice Address - Street 1:7600 SW 87TH AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3601
Practice Address - Country:US
Practice Address - Phone:305-275-5525
Practice Address - Fax:305-275-0662
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2011-12-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 59567208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05051OtherNHP
FL271580500Medicaid
FLP00239428OtherRAILROAD MEDICARE
FL18798OtherBLUE CROSS BLUE SHIELD
FL206819OtherAVMED
FL2000585OtherAETNA
FL18798TMedicare PIN
FL05051OtherNHP