Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | ME0029637 | FL |
NPI | 1023040243 |
---|---|
Provider Name | Dr. Domingo Gomez |
First Address | Hialeah, FL 33012-3637 |
Second Address | Hialeah, FL 33012-3637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 10/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
255666900 | (05) | FL |
D63291 | (02) | FL |