Provider Demographics
NPI:1427164284
Name:GOMEZ-SEOANE, EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:GOMEZ-SEOANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EDWARD
Other - Middle Name:
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5060 VILLA LINDE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3411
Mailing Address - Country:US
Mailing Address - Phone:810-733-5060
Mailing Address - Fax:810-733-7870
Practice Address - Street 1:5060 VILLA LINDE PARKWAY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3411
Practice Address - Country:US
Practice Address - Phone:810-733-5060
Practice Address - Fax:810-733-7870
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEG406295207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0252520Medicare ID - Type Unspecified
E49398Medicare UPIN
0252520Medicare PIN