Active NPI
Pastor Gomez Vazquez, M.D.
- Pediatrics Physician
- Lawton, OK
National Provider Identifier
1689635633
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- ME153892
- Practice address
- 1515 NE Lawrie Tatum Rd
Lawton, OK 73507-3099 - Phone
- (580) 354-5000
- NPI assigned
- Mar 29, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 4301088842 | MI | |
| Pediatrics Physician | 208000000X | 12082 | PR | |
| Pediatrics Physician | 208000000X | ME153892 | FL | Primary |
Addresses
Primary practice location
1515 NE Lawrie Tatum Rd
Lawton, OK 73507-3099
Mailing address
409 Hannah Ave.
Fletcher, OK 73541
Phone (580) 277-5544
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200207740A | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME153892 | FL | MD | Pediatrics Physician |
| 12082 | PR | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jackson County Memorial Hospital Authority | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- Altus, OK
- NPI 1093763781
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722902400000",
"number": "1689635633",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "409 HANNAH AVE.",
"city": "FLETCHER",
"state": "OK",
"postal_code": "73541",
"telephone_number": "580-277-5544"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1515 NE LAWRIE TATUM RD",
"city": "LAWTON",
"state": "OK",
"postal_code": "735073099",
"telephone_number": "580-354-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOMEZ VAZQUEZ",
"first_name": "PASTOR",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-29",
"last_updated": "2024-08-06",
"certification_date": "2024-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MI",
"license": "4301088842",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "PR",
"license": "12082",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "ME153892",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200207740A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lawton, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.