MEDICARE: DR. ERICK M GOMER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	60026184	WA
2	207Q00000X	Family Medicine Physician	A102422	CA
3	207Q00000X	Family Medicine Physician	38066	AZ
4	207Q00000X	Family Medicine Physician	50621	CO

General Provider Information

NPI Number	:	1356488639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERICK M GOMER MD

Provider Business Mailing Address
First Line	:	1030 JOHNSON RD
Second Line	:	SUITE 200
City	:	GOLDEN
State	:	CO
Zip	:	80401-6003
Country	:	US
Telephone Number	:	720-321-9300
Fax Number	:	720-321-9301

Provider Business Practice Location Address
First Line	:	1526 COLE BLVD STE 300
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80401-3410
Country	:	US
Telephone Number	:	303-379-9371
Fax Number	:	303-284-4082

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	04/27/2018

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