MEDICARE: DR. JORGE GOMEZ-VAZQUEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	J-4160	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	J-4160	OTHER	TX	TEXAS PHYSICAN PERMIT
3	N0087586	OTHER	TX	DPS REGISTRATION NUMBER

General Provider Information

NPI Number	:	1053470070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE GOMEZ-VAZQUEZ M.D.

Provider Business Mailing Address
First Line	:	6423 MCPHERSON RD STE 13
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78041-6144
Country	:	US
Telephone Number	:	956-452-1457
Fax Number	:

Provider Business Practice Location Address
First Line	:	6423 MCPHERSON RD STE 13
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78041-6144
Country	:	US
Telephone Number	:	956-452-1457
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	05/01/2025

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