Healthcare Provider Details

I. General information

NPI: 1740629021
Provider Name (Legal Business Name): TEOFILO GOZAINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 S 6TH ST
LEESVILLE LA
71446-4482
US

IV. Provider business mailing address

506 S 6TH ST
LEESVILLE LA
71446-4482
US

V. Phone/Fax

Practice location:
  • Phone: 337-239-2234
  • Fax: 337-239-2238
Mailing address:
  • Phone: 337-239-2234
  • Fax: 337-239-2238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD.1544OR
License Number StateLA

VIII. Authorized Official

Name: DR. TEOFILO GOZAINE
Title or Position: DOCTOR
Credential: M.D.
Phone: 337-239-2234