Basic Information
| Provider Information | |||||||||
| NPI: | 1972731024 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOMEZ | ||||||||
| FirstName: | RICARDO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12200 ACADEMY RD NE | ||||||||
| Address2: | APT # 213 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871117245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5599361151 | ||||||||
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| Practice Location | |||||||||
| Address1: | DEPT OF ANESTHESIA MSC 11 6120 | ||||||||
| Address2: | 1 UNIVERSITY OF NEW MEXICO | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871310001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052722610 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2009 | ||||||||
| LastUpdateDate: | 02/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD2013-0555 | NM | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 207L00000X | NM | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | MD2013-0555 | 01 | NM | NEW MEXICO MEDICAL LICENSE | OTHER | CS00219185 | 01 | NM | NEW MEXICO PHARMACY BOARD | OTHER |