Individual
WYLIE ELAURIA GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
245 N 15TH ST, MAIL STOP 427, PHILADELPHIA, PA 19102-1101
(215) 762-7916
Mailing address
245 N 15TH ST, MAIL STOP 427, PHILADELPHIA, PA 19102-1101
(215) 762-7916
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MT202797
PA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
54626
AZ
Other
Enumeration date
06/22/2012
Last updated
02/05/2019
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