Healthcare Provider Details

I. General information

NPI: 1619037595
Provider Name (Legal Business Name): ZOLTAN GOMBOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 COOLIDGE BLVD FL 3
LAFAYETTE LA
70503-2621
US

IV. Provider business mailing address

PO BOX 52087
LAFAYETTE LA
70505-2087
US

V. Phone/Fax

Practice location:
  • Phone: 337-289-7679
  • Fax:
Mailing address:
  • Phone: 337-289-7679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD423868
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD.201702
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: