Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 35077711 | OH |
NPI | 1144376856 |
---|---|
Provider Name | Dr. Dominic Gomes |
First Address | Lorain, OH 44053-3821 |
Second Address | Lorain, OH 44053-3821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 17/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2293772 | (05) | OH |
H33254 | (02) | OH |