Healthcare Provider Details

I. General information

NPI: 1023235579
Provider Name (Legal Business Name): CARLOS GOMEZ-MEADE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 E 41ST ST STE 200
TULSA OK
74135-5627
US

IV. Provider business mailing address

5801 E 41ST ST STE 200
TULSA OK
74135-5627
US

V. Phone/Fax

Practice location:
  • Phone: 918-293-9966
  • Fax: 918-293-9988
Mailing address:
  • Phone: 918-293-9966
  • Fax: 918-293-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number6596
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number6596
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberP0829
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberP0829
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: