Individual
AGNES GOMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2444 W FAIDLEY AVE, GRAND ISLAND, NE 68803-4327
(308) 382-1100
(308) 385-0796
Mailing address
PO BOX 550, GRAND ISLAND, NE 68802-0550
(308) 382-1100
(308) 385-0796
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
13219
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00819
BCBS
NE
05
—
47017633037
—
NE
01
—
5931
MIDLANDS CHOICE
NE
Enumeration date
07/29/2005
Last updated
11/05/2007
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