Provider Demographics
NPI:1891542205
Name:GOMES, MARK A
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:GOMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11014 MADERIA ST
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-4966
Mailing Address - Country:US
Mailing Address - Phone:352-263-1383
Mailing Address - Fax:
Practice Address - Street 1:11014 MADERIA ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-4966
Practice Address - Country:US
Practice Address - Phone:352-263-1383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1519662471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography