Provider Demographics
NPI:1598439952
Name:GOMEZ, MARCO ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:ANTONIO
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:EB39 CALLE ROSA DE FRANCIA
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4712
Mailing Address - Country:US
Mailing Address - Phone:803-476-7678
Mailing Address - Fax:
Practice Address - Street 1:EB39 CALLE ROSA DE FRANCIA
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4712
Practice Address - Country:US
Practice Address - Phone:803-476-7678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-08
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23203208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty