Healthcare Provider Details

I. General information

NPI: 1699705442
Provider Name (Legal Business Name): FERNANDO L. GOMEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7806 LAKE UNDERHILL RD SUITE 105
ORLANDO FL
32822-8232
US

IV. Provider business mailing address

7806 LAKE UNDERHILL RD SUITE 105
ORLANDO FL
32822-8232
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 NumberME78577
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: