Provider Demographics
NPI:1699705442
Name:GOMEZ, FERNANDO L (MD)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:L
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 1:7806 LAKE UNDERHILL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-8232
Mailing Address - Country:US
Mailing Address - Phone:407-281-9229
Mailing Address - Fax:407-207-7180
Practice Address - Street 1:7806 LAKE UNDERHILL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8232
Practice Address - Country:US
Practice Address - Phone:407-281-9229
Practice Address - Fax:407-207-7180
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78577207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264214000Medicaid
FL35717ZMedicare ID - Type Unspecified
FL264214000Medicaid