Healthcare Provider Details

I. General information

NPI: 1003910795
Provider Name (Legal Business Name): CARLOS E GOMEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 851 BOX 340
FPO AE
09834-0004
US

IV. Provider business mailing address

PSC 851 BOX 340
FPO AE
09834-0004
US

V. Phone/Fax

Practice location:
  • Phone: 318-439-8124
  • Fax:
Mailing address:
  • Phone: 318-439-8124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME91180
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: