Provider Demographics
NPI:1427083351
Name:GOMEZ, JOSE J (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:J
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 1:601 SE WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-3319
Mailing Address - Country:US
Mailing Address - Phone:580-286-6688
Mailing Address - Fax:580-286-6699
Practice Address - Street 1:601 SE WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-3319
Practice Address - Country:US
Practice Address - Phone:580-286-6688
Practice Address - Fax:580-286-6699
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9788207Q00000X
OK25506207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8038B7Medicare ID - Type Unspecified
TX8961B6Medicare ID - Type Unspecified
TXH24369Medicare UPIN