Provider Demographics
NPI:1609873504
Name:GOMEZ, JESUS ALBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:ALBERTO
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:INES
Other - Middle Name:JOAN
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:7848 GATEWAY BLVD E
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-1815
Practice Address - Country:US
Practice Address - Phone:915-544-6750
Practice Address - Fax:915-599-1701
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2409174400000X
WAH2409207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM87629551Medicaid
TX133951709Medicaid
TX133951710Medicaid
TX155014701Medicaid
TX8A0549Medicare ID - Type Unspecified
TX133951710Medicaid
TX155014701Medicaid
TXTXB103315Medicare PIN