Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | P0829 | TX |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 6596 | OK |
N | 207ND0101X | MOHS-Micrographic Surgeon | P0829 | TX |
NPI | 1023235579 |
---|---|
Provider Name | Dr. Carlos Gomez-Meade |
First Address | Broken Arrow, OK 74012 |
Second Address | Broken Arrow, OK 74012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 25/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
302669201 | (05) | TX |