Healthcare Provider Details

I. General information

NPI: 1740281799
Provider Name (Legal Business Name): ANNE LOUISE GOMEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 E MEDICAL CENTER DR
ST GEORGE UT
84790-2123
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 435-251-2730
  • Fax:
Mailing address:
  • Phone:
  • Fax: 575-524-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK2872
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2013-0976
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberK2872
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14185785-1235
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier53127064
Identifier TypeMEDICAID
Identifier StateNM
Identifier Issuer
# 2
Identifier122414912
Identifier TypeMEDICAID
Identifier StateTX
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: