MEDICARE: DR. HENRY L. GOMEZ

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	208000000X	Pediatrics Physician	E-1534	AR

General Provider Information

NPI Number	:	1366621252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. HENRY L. GOMEZ

Provider Business Mailing Address
First Line	:	403 W OAK ST
Second Line	:	SUITE 305
City	:	EL DORADO
State	:	AR
Zip	:	71730-4586
Country	:	US
Telephone Number	:	870-863-3131
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 W OAK ST
Second Line	:	SUITE 305
City	:	EL DORADO
State	:	AR
Zip	:	71730-4586
Country	:	US
Telephone Number	:	870-863-3131
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. HENRY LUSI GOMEZ
Credential	:	M.D.
Telephone Number	:	870-863-3131

Provider Enumeration Date	:	10/29/2007
Last Update Date	:	10/29/2007

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