Provider Demographics
NPI:1528165289
Name:GOMEZ, EDWARD R (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:R
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 GATEWAY BLVD W
Mailing Address - Street 2:STE. 120
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3331
Mailing Address - Country:US
Mailing Address - Phone:915-779-1716
Mailing Address - Fax:915-771-6558
Practice Address - Street 1:1700 N OREGON ST
Practice Address - Street 2:STE. 550
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3584
Practice Address - Country:US
Practice Address - Phone:915-532-7797
Practice Address - Fax:915-544-9733
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH38162086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00679DOtherBCBS
TX00679DOtherBCBS
TX00679DMedicare PIN