Individual
BRIAN JACOB GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC, USN
Contact information
Practice address
5555 N CHANNEL AVE, PORTLAND, OR 97217-7655
(619) 545-0475
Mailing address
550 POPE AVE, FORT LEAVENWORTH, KS 66027-2332
(619) 545-0475
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
06/06/2024
Last updated
04/12/2026
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