Individual
DR. EDWIN ANTONIO GOMEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1040 WESTON RD, SUITE 210, WESTON, FL 33326-1912
(954) 766-4702
(954) 766-4907
Mailing address
1040 WESTON RD, STE 210, WESTON, FL 33326-1912
(954) 766-4702
(954) 766-4907
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME97741
FL
2084P0804X
Child & Adolescent Psychiatry Physician
ME97741
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001441900
—
FL
01
—
GM814A
GROUP MEDICARE PTAN
FL
Enumeration date
09/28/2006
Last updated
01/13/2014
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