| Stasha Gominak, Md, Pa | |
|
700 Olympic Plaza Cir Suite 912 Tyler TX 75701-1951 | |
| (903) 596-3808 | |
| (903) 596-3815 |
| Full Name | Stasha Gominak, Md, Pa |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 700 Olympic Plaza Cir, Tyler, Texas |
| Authorized Official Name and Position | Stasha C Gominak (PHYSICIAN) |
| Authorized Official Contact | 9035963808 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Stasha Gominak, Md, Pa 700 Olympic Plaza Cir 912 Tyler TX 75701-1951 Ph: (903) 596-3808 | Stasha Gominak, Md, Pa 700 Olympic Plaza Cir Suite 912 Tyler TX 75701-1951 Ph: (903) 596-3808 |
| NPI Number | 1356524862 |
|---|---|
| Provider Enumeration Date | 12/07/2007 |
| Last Update Date | 09/28/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356524862 | NPI | - | NPPES |
| 0086KV | Other | TX | BCBS |
| DB5632 | Other | TX | RAILROAD MEDICARE |
| 164213401 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
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