Individual
MS. STASHA C GOMINAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
700 OLYMPIC PLAZA CIR, STE 912, TYLER, TX 75701-1951
(903) 596-3808
(903) 596-3815
Mailing address
700 OLYMPIC PLAZA CIR, STE 912, TYLER, TX 75701-1951
(903) 596-3808
(903) 596-3815
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
G5098
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164215901
—
TX
01
—
8K7990
BCBS
TX
Enumeration date
08/21/2006
Last updated
07/30/2009
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