Basic Information
| Provider Information | |||||||||
| NPI: | 1003934365 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOMEZ | ||||||||
| FirstName: | FELIPE | ||||||||
| MiddleName: | DE JESUS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1605 E INTERSTATE HIGHWAY 2 STE D | ||||||||
| Address2: | |||||||||
| City: | MISSION | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785726607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9565851564 | ||||||||
| FaxNumber: | 9565852830 | ||||||||
| Practice Location | |||||||||
| Address1: | 1605 E INTERSTATE HIGHWAY 2 | ||||||||
| Address2: | STE D | ||||||||
| City: | MISSION | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785726607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563623520 | ||||||||
| FaxNumber: | 9563623529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 03/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | J4825 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 115387608 | 05 | TX | MEDICAID | AG3137634 | 01 | TX | DEA NUMBER | OTHER | 115387609 | 01 | TX | MEDICAID-CSHCN | OTHER | 84170X | 01 | TX | BCBS INDIVIDUAL NUMBER | OTHER |