Basic Information
Provider Information
NPI: 1720033376
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GOMEZ
FirstName: GENE
MiddleName: MICHAEL
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 325 E PIONEER
Address2:  
City: PUYALLUP
State: WA
PostalCode: 983723265
CountryCode: US
TelephoneNumber: 2536978400
FaxNumber:  
Practice Location
Address1: 4238 AUBURN WAY N
Address2:  
City: AUBURN
State: WA
PostalCode: 980021311
CountryCode: US
TelephoneNumber: 2538767600
FaxNumber: 2538767610
Other Information
ProviderEnumerationDate: 05/23/2006
LastUpdateDate: 03/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800XMD60480708WAY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
2084P0800X8526911-1205UTN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

ID Information
IDTypeStateIssuerDescription
172003337605UT MEDICAID


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