MEDICARE: EDUARDO R 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	2085R0202X	Diagnostic Radiology Physician	30038	KY

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
2	000000354933	OTHER	KY	BCBS

General Provider Information

NPI Number	:	1700921509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDUARDO R GOMEZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 32364
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37930-2364
Country	:	US
Telephone Number	:	865-531-6070
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 NEWCOMB AVE
Second Line	:
City	:	MOUNT VERNON
State	:	KY
Zip	:	40456-2733
Country	:	US
Telephone Number	:	606-256-2195
Fax Number	:

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/13/2007

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