Provider Demographics
NPI:1528299567
Name:GOMEZ, RICHARD (LOA)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:LOA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN BLDG C
Mailing Address - Street 2:SUITE 406
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2505
Mailing Address - Country:US
Mailing Address - Phone:972-566-4999
Mailing Address - Fax:972-566-7002
Practice Address - Street 1:7777 FOREST LN BLDG C
Practice Address - Street 2:SUITE 406
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:972-566-4999
Practice Address - Fax:972-566-7002
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX425222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist