Individual
DR. MAURICIO GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1319 S LANDRUM ST, MOUNT VERNON, MO 65712-1910
(417) 466-2001
(417) 466-2005
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2015021625
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316201312
—
MO
Enumeration date
06/25/2012
Last updated
12/17/2024
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