Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 4301062072 | MI |
N | 207PP0204X | Pediatric Emergency Physician | 4301062072 | MI |
N | 207R00000X | Internist | 4301062072 | MI |
N | 111NI0900X | Internist | 4301062072 | MI |
NPI | 1154419562 |
---|---|
Provider Name | Dr. Hernan F. Gomez |
First Address | Flint, MI 48503-5902 |
Second Address | Flint, MI 48503-5902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0B51090 | BLUE SHIELD (01) | MI |
3441920 | (05) | MI |
E47392 | (02) | MI |