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Contact Information

KELLY A GOMEZ, DPM
777 N 500 W
SUITE 103
PROVO, UT84601
 Phone: 801-375-6677
 Fax: 801-375-0346
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgery, Foot & Ankle

213ES0103X 48 Podiatry
 

Podiatrist

213E00000X 48 Podiatry
Indicates primary specialty

NPI Profile & details for KELLY A GOMEZ · (Male)

NPI # 1821021957
Status Active
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 07/09/2006
Last updated 01/14/2015 - About 11 years ago
Sole proprietor 1 No
Identifiers
  • UT License # 367951
  • UT Other 000064004 MEDICARE PTAN #
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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