Healthcare Provider Details

I. General information

NPI: 1477996213
Provider Name (Legal Business Name): JUAN CAMILO GOMEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 SW 37TH AVE STE 904
CORAL GABLES FL
33133-2751
US

IV. Provider business mailing address

2601 SW 37TH AVE STE 904
CORAL GABLES FL
33133-2751
US

V. Phone/Fax

Practice location:
  • Phone: 305-283-8375
  • Fax:
Mailing address:
  • Phone: 305-283-8375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME121382
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberME121382
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: