MEDICARE: DR. MINVERVA GOMEZ

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	H3677	TX

General Provider Information

NPI Number	:	1508810383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MINVERVA GOMEZ

Provider Business Mailing Address
First Line	:	14020 COIT RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-3706
Country	:	US
Telephone Number	:	214-570-0703
Fax Number	:

Provider Business Practice Location Address
First Line	:	14020 COIT RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-3706
Country	:	US
Telephone Number	:	214-570-0703
Fax Number	:

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. MINVERVA GOMEZ ” Practice Location

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