MEDICARE: DALYS F GOMEZ 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	174400000X	Specialist	K2704	TX

General Provider Information

NPI Number	:	1558367508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALYS F GOMEZ M.D.

Provider Business Mailing Address
First Line	:	3322 PRINCE GEORGE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-3930
Country	:	US
Telephone Number	:	210-687-1222
Fax Number	:	210-698-1110

Provider Business Practice Location Address
First Line	:	24165 IH 10 W
Second Line	:	STE 126
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-1109
Country	:	US
Telephone Number	:	210-687-1222
Fax Number	:	210-698-1110

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	07/08/2007

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