Individual
OLIVER DIAZ GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
764 LAKELAND DR, JACKSON, MS 39216-4651
(601) 984-6800
Mailing address
1204 GREYMONT AVE, JACKSON, MS 39202-2155
(407) 968-1080
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
T-5115
MS
Other
Enumeration date
04/10/2023
Last updated
07/01/2023
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