Healthcare Provider Details

I. General information

NPI: 1518994250
Provider Name (Legal Business Name): HENRY L GOMEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 FRED LAGRONE DR
CROSSETT AR
71635-4546
US

IV. Provider business mailing address

PO BOX H
CROSSETT AR
71635-1808
US

V. Phone/Fax

Practice location:
  • Phone: 870-364-3800
  • Fax:
Mailing address:
  • Phone: 870-364-4111
  • Fax: 870-364-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE1534
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: