Healthcare Provider Details

I. General information

NPI: 1073302832
Provider Name (Legal Business Name): GARRETT GOMEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 E 29TH ST STE 100
BRYAN TX
77802-2623
US

IV. Provider business mailing address

1410 CANYON BRK
SAN ANTONIO TX
78248-2614
US

V. Phone/Fax

Practice location:
  • Phone: 979-776-8440
  • Fax:
Mailing address:
  • Phone: 903-821-1175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: