MEDICARE: ROY C GOMEZ, MD, PC

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	261QP2300X	Primary Care Clinic/Center	0101031258	VA

General Provider Information

NPI Number	:	1841472040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROY C GOMEZ, MD, PC

Provider Business Mailing Address
First Line	:	PO BOX 690
Second Line	:
City	:	CEDAR BLUFF
State	:	VA
Zip	:	24609-0690
Country	:	US
Telephone Number	:	276-963-9616
Fax Number	:	276-963-3897

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

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROY C GOMEZ
Credential	:	MD
Telephone Number	:	276-963-9616

Provider Enumeration Date	:	11/29/2007
Last Update Date	:	11/29/2007

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