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NPI Code Detail

MEDICARE: DR. LUIS L GOMEZ MD

MEDICARE: DR. LUIS L GOMEZ MD
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
1207Q00000XFamily Medicine PhysicianMD018911YPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1GO43342OTHERPAHIGHMARK NUMBER

General Provider Information

NPI Number : 1093766156
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LUIS L GOMEZ MD
Provider Business Mailing Address
First Line : 505 POPLAR ST
Second Line :
City : MEADVILLE
State : PA
Zip : 16335-3057
Country : US
Telephone Number : 814-336-6068
Fax Number : 814-337-0198
Provider Business Practice Location Address
First Line : 505 POPLAR ST
Second Line :
City : MEADVILLE
State : PA
Zip : 16335-3057
Country : US
Telephone Number : 814-336-6068
Fax Number : 814-337-0198
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2006
Last Update Date : 03/29/2016

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