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Provider Information for 1093702714

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

ALISON KAY GOMEZ M.D.

Other Name:   ALISON DALRYMPLE
Gender: FEMALE

Individual NPI: 1093702714

Calendar   Last Updated:  2016-01-21
  Certification Date: 

Details

Name Value
NPI 1093702714
Enumeration Date 2005-09-29
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 740 REENA AVE
FORT ATKINSON, WI 53538-3145
United States

Phone: 920-563-0888 | Fax: 920-568-3516
View Map External Link
Primary Practice Address 740 REENA AVE
FORT ATKINSON, WI 53538-3145
United States

Phone: 920-563-0888 | Fax: 920-568-3516
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID WI 1093702714
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 207Q00000X - Family Medicine WI 34614