Individual
ANDRE JAYLAN GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
700 NE 13TH ST, OKLAHOMA CITY, OK 73104-5004
(405) 271-4700
Mailing address
123 NE 2ND ST APT 311, OKLAHOMA CITY, OK 73104-2264
(575) 390-4202
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
4953
OK
208M00000X
Hospitalist Physician
Primary
PA4953
OK
363AM0700X
Medical Physician Assistant
4953
OK
Other
Enumeration date
10/03/2022
Last updated
12/06/2022
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