Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 12396 | PR |
Y | 208D00000X | General Practice Physician | ACN775 | FL |
NPI | 1013014281 |
---|---|
Provider Name | Dr. Gerardo Gomez Cordoba |
First Address | Homestead, FL 33032-8001 |
Second Address | Tampa, FL 33612-7900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 07/05/2019 |