Provider Demographics
NPI:1053807388
Name:GOMEZ QUEVEDO, OSWALDO ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:OSWALDO
Middle Name:ANTONIO
Last Name:GOMEZ QUEVEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 7TH AVE S # JFL300
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1711
Mailing Address - Country:US
Mailing Address - Phone:205-638-9688
Mailing Address - Fax:205-975-4972
Practice Address - Street 1:1600 7TH AVE S # JFL300
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1711
Practice Address - Country:US
Practice Address - Phone:205-638-9688
Practice Address - Fax:205-975-4972
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL.5391F2086S0120X
MO13830208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery