Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 13830 | MO |
Y | 208600000X | Surgeon | 13830 | MO |
N | 2086S0120X | Pediatric Surgery | L.5391F | AL |
NPI | 1053807388 |
---|---|
Provider Name | Oswaldo Antonio Gomez Quevedo |
First Address | Birmingham, AL 35233-1711 |
Second Address | Birmingham, AL 35233-1711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2018 |
Last Update Date | 04/08/2021 |