Healthcare Provider Details

I. General information

NPI: 1457374068
Provider Name (Legal Business Name): JORGE L GOMEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 SUNSET DR SUITE 301
SOUTH MIAMI FL
33143-4828
US

IV. Provider business mailing address

6200 SUNSET DRIVE SUITE 301
MIAMI FL
33143-4829
US

V. Phone/Fax

Practice location:
  • Phone: 305-669-9521
  • Fax: 305-669-9735
Mailing address:
  • Phone: 305-669-9521
  • Fax: 305-669-9735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberME67794
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: