Healthcare Provider Details

I. General information

NPI: 1942615034
Provider Name (Legal Business Name): OMAR A. GOMEZ, M.D.P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 FM 156 S SUITE 100
HASLET TX
76052-3605
US

IV. Provider business mailing address

590 FM 156 S SUITE 100
HASLET TX
76052-3605
US

V. Phone/Fax

Practice location:
  • Phone: 817-439-0303
  • Fax: 817-847-1353
Mailing address:
  • Phone: 817-439-0303
  • Fax: 817-847-1353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: OMAR A. GOMEZ
Title or Position: OWNER
Credential: M.D.
Phone: 817-439-0303