Healthcare Provider Details

I. General information

NPI: 1699797191
Provider Name (Legal Business Name): RICARDO GOMEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HENRY CLAY AVENUE
NEW ORLEANS LA
70118
US

IV. Provider business mailing address

200 HENRY CLAY AVENUE
NEW ORLEANS LA
70118
US

V. Phone/Fax

Practice location:
  • Phone: 504-896-2723
  • Fax: 504-896-2720
Mailing address:
  • Phone: 504-896-2723
  • Fax: 504-896-2720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number024207
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number024207
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: