Healthcare Provider Details

I. General information

NPI: 1104004688
Provider Name (Legal Business Name): FERNANDO L GOMEZ MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 SOUTH CHICKASAW TRAIL SUITE 310
ORLANDO FL
32825-8232
US

IV. Provider business mailing address

258 S CHICKASAW TRL SUITE 310
ORLANDO FL
32825-3501
US

V. Phone/Fax

Practice location:
  • Phone: 407-281-9229
  • Fax: 407-207-7180
Mailing address:
  • Phone: 407-281-9229
  • Fax: 407-207-7180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: FERNANDO L GOMEZ
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 407-281-9229