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General NPI Number Information
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NPI Number | 1043562606
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Entity Type | Individual
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Provider Name | ROGER GOMEZ PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/08/2012
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 1414 GREEN OAK TERRACE CT STE 200
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City | KINGWOOD
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State | TX
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Zip | 77339-2960
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Country | US
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Telephone | 832-846-5551
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Fax |
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Provider Business Mailing Address
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Address Line | 17604 NORTHERN HARRIER CT
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City | CONROE
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State | TX
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Zip | 77385-3843
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Country | US
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Telephone | 910-987-3689
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 001003771
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA13891
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License Number State | TX
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