Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 233082 | MA |
NPI | 1225365430 |
---|---|
Provider Name | Dr. Antonio Gomez |
First Address | Boston, MA 02215-3926 |
Second Address | Boston, MA 02215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2009 |
Last Update Date | 09/11/2009 |