Provider Demographics
NPI:1043562606
Name:GOMEZ, ROGER (PA-C)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:ROGER
Other - Middle Name:
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:17604 NORTHERN HARRIER CT
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-3843
Mailing Address - Country:US
Mailing Address - Phone:910-987-3689
Mailing Address - Fax:
Practice Address - Street 1:1414 GREEN OAK TERRACE CT STE 200
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2960
Practice Address - Country:US
Practice Address - Phone:832-846-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001003771363A00000X
TXPA13891363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant