| Doctor Name: | DR. RAFAEL M GOMEZ |
| NPI Number: | 1962403162 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | ME28018 |
| Business Practice Address: | 1032 Mar Walt Dr Suite 210 Fort Walton Beach, FL - 325476661 |
| Business Phone Number: | 8508638260 |
| Business Fax Number: | 8508626098 |
| Mailing Address: | 1005 Mar Walt Dr, Administration FORT WALTON BEACH |
| State: | FL |
| Postal Code: | 325476707 |
| Phone Number: | 8508638100 |
| Fax Number: | 8508634152 |
| NPI Enumeration Date: | 08/10/2005 |
| NPI Last Update Date: | 03/04/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | ME28018 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |