Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 83233 | GA |
NPI | 1336582626 |
---|---|
Provider Name | Mr. Charles D Gomez |
First Address | Loma Linda, CA 92354-2804 |
Second Address | Macon, GA 31201-2100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2013 |
Last Update Date | 23/09/2019 |