Basic Information
| Provider Information | |||||||||
| NPI: | 1942418991 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOMEZ | ||||||||
| FirstName: | PABLO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 615 E PRINCETON ST | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328031456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073035781 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 615 E PRINCETON ST | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328031456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073035781 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 08/02/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 239872 | MA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2088P0231X | ME112990 | FL | Y | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology |
No ID Information.