MEDICARE: DR. TEOFILO GOZAINE 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	207Y00000X	Otolaryngology Physician	35888	WV
2	207Y00000X	Otolaryngology Physician	15440R	LA
3	207Y00000X	Otolaryngology Physician	80003	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598764102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TEOFILO GOZAINE MD

Provider Business Mailing Address
First Line	:	506 S 6TH ST
Second Line	:
City	:	LEESVILLE
State	:	LA
Zip	:	71446-4482
Country	:	US
Telephone Number	:	337-239-2234
Fax Number	:	337-239-2238

Provider Business Practice Location Address
First Line	:	830 PENNSYLVANIA AVE STE 204
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25302-3389
Country	:	US
Telephone Number	:	304-388-2980
Fax Number	:

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	02/10/2026

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Directions to “ DR. TEOFILO GOZAINE MD” Practice Location

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