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General NPI Number Information
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NPI Number | 1689635633
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Entity Type | Individual
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Provider Name | PASTOR GOMEZ VAZQUEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 1515 NE LAWRIE TATUM RD
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City | LAWTON
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State | OK
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Zip | 73507-3099
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Country | US
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Telephone | 580-354-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 409 HANNAH AVE.
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City | FLETCHER
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State | OK
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Zip | 73541
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Country | US
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Telephone | 580-277-5544
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301088842
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 12082
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME153892
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License Number State | FL
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