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General NPI Number Information
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NPI Number | 1750880134
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Entity Type | Individual
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Provider Name | ROBERT GOMANN GENOVESE II PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/12/2018
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Last Update Date | 02/12/2018
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Provider Practice Location Address
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Address Line | 1233 WAYNE GILMORE CIR STE 250A
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City | OPELOUSAS
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State | LA
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Zip | 70570-6405
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Country | US
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Telephone | 337-948-8556
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Fax | 337-948-6881
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Provider Business Mailing Address
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Address Line | 3306 WALNUT DR
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City | OPELOUSAS
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State | LA
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Zip | 70570-6946
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Country | US
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Telephone | 337-945-4695
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 307277
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License Number State | LA
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