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Organization
EL PASO VASCULAR P A
Active
Organization
EL PASO VASCULAR P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD GOMEZ MD (OWNER)
(915) 577-8346
Entity
Organization
Contact information
Practice address
4532 N MESA ST, EL PASO, TX 79912
(915) 577-8346
(915) 577-7932
Mailing address
5959 GATEWAY BLVD W, STE 120, EL PASO, TX 79925-3331
(915) 779-1716
(915) 771-6496
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
H3816
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00679D
MEDICARE PTAN
TX
05
—
030882701
—
TX
Enumeration date
11/11/2016
Last updated
08/27/2018
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