MEDICARE: CRISTOBAL GOMEZ DUARTE 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	207RG0100X	Gastroenterology Physician	5846	PR

General Provider Information

NPI Number	:	1972589414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTOBAL GOMEZ DUARTE MD

Provider Business Mailing Address
First Line	:	690 CALLE CESAR GONZALEZ
Second Line	:	APT PH307
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3913
Country	:	US
Telephone Number	:	787-722-1717
Fax Number	:	787-723-1595

Provider Business Practice Location Address
First Line	:	1449 AMERICO SALAS
Second Line	:	STE 103
City	:	SAN JUAN
State	:	PR
Zip	:	00909-2104
Country	:	US
Telephone Number	:	787-722-1717
Fax Number	:	787-723-1595

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

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	02/14/2012

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