MEDICARE: DR. ATANACIO 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
1	207QS0010X	Sports Medicine (Family Medicine) Physician	DR.0073285	CO
2	207Q00000X	Family Medicine Physician	DR0073285	CO

General Provider Information

NPI Number	:	1114456449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ATANACIO GOMEZ MD

Provider Business Mailing Address
First Line	:	2461 FLAT TOP LN UNIT A
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1613
Country	:	US
Telephone Number	:	830-752-7003
Fax Number	:

Provider Business Practice Location Address
First Line	:	2461 FLAT TOP LN UNIT A
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1613
Country	:	US
Telephone Number	:	830-752-7003
Fax Number	:

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

Provider Enumeration Date	:	06/09/2017
Last Update Date	:	02/17/2026

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