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General NPI Number Information
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NPI Number | 1598439952
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Entity Type | Individual
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Provider Name | MARCO ANTONIO GOMEZ MD
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Gender | Male
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Dates
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Enumeration Date | 08/08/2021
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Last Update Date | 05/17/2023
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Provider Practice Location Address
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Address Line | EB39 CALLE ROSA DE FRANCIA
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City | TOA BAJA
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State | PR
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Zip | 00949-4712
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Country | US
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Telephone | 803-476-7678
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Fax |
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Provider Business Mailing Address
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Address Line | EB39 CALLE ROSA DE FRANCIA
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City | TOA BAJA
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State | PR
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Zip | 00949-4712
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Country | US
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Telephone | 803-476-7678
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 23203
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License Number State | PR
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