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NPI Code Detail

MEDICARE: RICHARD LEE SHOMO PA

MEDICARE: RICHARD LEE SHOMO PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA04261TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21049767OTHERNATIONAL CERTIFICATION
3PA04261OTHERTXLICENSE
4PA200160OTHERLALICENSE

General Provider Information

NPI Number : 1609853720
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD LEE SHOMO PA
Provider Business Mailing Address
First Line : 1009 DEBORAH DR
Second Line :
City : SLIDELL
State : LA
Zip : 70461-5368
Country : US
Telephone Number : 504-678-8148
Fax Number : 504-678-1596
Provider Business Practice Location Address
First Line : 2300 GENERAL MEYER AVE
Second Line : BLDG H100
City : NEW ORLEANS
State : LA
Zip : 70142-0001
Country : US
Telephone Number : 504-678-8148
Fax Number : 504-678-1596
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2005
Last Update Date : 06/04/2008

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Directions to “ RICHARD LEE SHOMO PA” Practice Location

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