Organization
STASHA GOMINAK, MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STASHA C GOMINAK M.D. (PHYSICIAN)
(903) 596-3808
Entity
Organization
Contact information
Practice address
700 OLYMPIC PLAZA CIR, SUITE 912, TYLER, TX 75701-1951
(903) 596-3808
(903) 596-3815
Mailing address
700 OLYMPIC PLAZA CIR, 912, TYLER, TX 75701-1951
(903) 596-3808
(903) 596-3815
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0086KV
BCBS
TX
05
—
164213401
—
TX
01
—
DB5632
RAILROAD MEDICARE
TX
Enumeration date
12/07/2007
Last updated
09/28/2012
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