MEDICARE: DR. ROY CLEMENT 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	207Q00000X	Family Medicine Physician	0101031258	VA
2	208000000X	Pediatrics Physician	0101031258	VA

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

General Provider Information

NPI Number	:	1598726846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROY CLEMENT GOMEZ MD

Provider Business Mailing Address
First Line	:	281 LINWOOD DR
Second Line	:
City	:	RICHLANDS
State	:	VA
Zip	:	24641-3606
Country	:	US
Telephone Number	:	276-963-9616
Fax Number	:	276-963-3897

Provider Business Practice Location Address
First Line	:	2308 CEDAR VALLEY DR
Second Line	:
City	:	CEDAR BLUFF
State	:	VA
Zip	:	24609-9302
Country	:	US
Telephone Number	:	276-963-9616
Fax Number	:	276-963-3897

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	10/23/2007

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