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NPI Code Detail

MEDICARE: JEREMIAH GOMEZ

MEDICARE: JEREMIAH 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
1363LF0000XFamily Nurse PractitionerF1180287TX
2208M00000XHospitalist PhysicianF11180287TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1942771597
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREMIAH GOMEZ
Provider Business Mailing Address
First Line : 7703 FLOYD CURL DR
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78229-3901
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4502 MEDICAL DR
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78229-4492
Country : US
Telephone Number : 210-358-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2018
Last Update Date : 10/07/2022

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Directions to “ JEREMIAH GOMEZ ” Practice Location

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