Healthcare Provider Details

I. General information

NPI: 1609972751
Provider Name (Legal Business Name): RAFAEL T. GOMEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 NE 55TH BOULEVARD NFETC
GAINESVILLE FL
32641-2759
US

IV. Provider business mailing address

1200 NE 55TH BOULEVARD NORTH FLORIDA EDUCATION & TREATMENT CENTER
GAINESVILLE FL
32641-2759
US

V. Phone/Fax

Practice location:
  • Phone: 352-375-8484
  • Fax: 352-264-8304
Mailing address:
  • Phone: 352-375-8484
  • Fax: 352-264-8304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME25088
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25088
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: