# EL PASO VASCULAR P A

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245772987
- **Authorized official:** EDWARD GOMEZ MD (OWNER)
- **Authorized official phone:** (915) 577-8346

## Contact information

- **Practice address:** 4532 N MESA ST, EL PASO, TX 79912
- **Practice address phone:** (915) 577-8346
- **Practice address fax:** (915) 577-7932
- **Mailing address:** 5959 GATEWAY BLVD W, STE 120, EL PASO, TX 79925-3331
- **Mailing address phone:** (915) 779-1716
- **Mailing address fax:** (915) 771-6496

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | H3816 | TX | Yes |

## Other

- **Enumeration date:** 11/11/2016
- **Last updated:** 08/27/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 00679D | MEDICARE PTAN | TX |
| 05 | — | 030882701 | — | TX |