Healthcare Provider Details

I. General information

NPI: 1306367008
Provider Name (Legal Business Name): MARY ELIZABETH GOMEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 N ALVERNON WAY
TUCSON AZ
85712-3321
US

IV. Provider business mailing address

5055 E BROADWAY BLVD STE A100
TUCSON AZ
85711-3629
US

V. Phone/Fax

Practice location:
  • Phone: 520-325-8000
  • Fax: 520-325-8616
Mailing address:
  • Phone: 520-327-0460
  • Fax: 520-226-0092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP10060930
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number69151
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: