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1841293636

NPI Code Detail

MEDICARE: MANUEL ANTONIO GOMEZ MD

MEDICARE: MANUEL ANTONIO 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	10506	WV
2	207ZC0500X	Cytopathology Physician	10506	WV

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841293636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANUEL ANTONIO GOMEZ MD

Provider Business Mailing Address
First Line	:	PO BOX 130
Second Line	:
City	:	MAXWELTON
State	:	WV
Zip	:	24957-0130
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 W MAIN ST
Second Line	:
City	:	WHITE SULPHUR SPRINGS
State	:	WV
Zip	:	24986-2414
Country	:	US
Telephone Number	:	304-647-6061
Fax Number	:

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	01/19/2017

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Directions to “ MANUEL ANTONIO GOMEZ MD” Practice Location

Language	Start Address	Practice Location

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