Healthcare Provider Details

I. General information

NPI: 1598726846
Provider Name (Legal Business Name): ROY CLEMENT GOMEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2308 CEDAR VALLEY DR
CEDAR BLUFF VA
24609-9302
US

IV. Provider business mailing address

281 LINWOOD DR
RICHLANDS VA
24641-3606
US

V. Phone/Fax

Practice location:
  • Phone: 276-963-9616
  • Fax: 276-963-3897
Mailing address:
  • Phone: 276-963-9616
  • Fax: 276-963-3897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101031258
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101031258
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: