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NPI Code Detail

MEDICARE: DOLORES M GOMEZ MD

MEDICARE: DOLORES M GOMEZ 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
1207Q00000XFamily Medicine Physician29739AZ
2207Q00000XFamily Medicine Physician2001-40NM

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1200521039OTHERMEDICARE GROUP

General Provider Information

NPI Number : 1750320917
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOLORES M GOMEZ MD
Provider Business Mailing Address
First Line : 2450 S TELSHOR BLVD
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-5069
Country : US
Telephone Number : 575-521-5277
Fax Number :
Provider Business Practice Location Address
First Line : 2450 S TELSHOR BLVD
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-5069
Country : US
Telephone Number : 575-521-5277
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2006
Last Update Date : 12/04/2012

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Directions to “ DOLORES M GOMEZ MD” Practice Location

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