Individual
MANUEL ANTONIO GOMEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
320 W MAIN ST, WHITE SULPHUR SPRINGS, WV 24986-2414
(304) 647-6061
Mailing address
PO BOX 130, MAXWELTON, WV 24957-0130
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
10506
WV
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
10506
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000650961
—
VA
05
—
0102000000
—
WV
Enumeration date
05/24/2005
Last updated
01/19/2017
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