MEDICARE: DR. LOUIS SHELBY CASSO-GOMEZ MD

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
1	207R00000X	Internal Medicine Physician	60238536	WA

General Provider Information

NPI Number	:	1033433313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUIS SHELBY CASSO-GOMEZ MD

Provider Business Mailing Address
First Line	:	430 SW 13TH AVE APT 1617
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-2371
Country	:	US
Telephone Number	:	210-392-3377
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 SW 13TH AVE APT 1617
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-2371
Country	:	US
Telephone Number	:	210-392-3377
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2010
Last Update Date	:	12/20/2018

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