Provider Demographics
NPI:1033433313
Name:CASSO-GOMEZ, LOUIS SHELBY (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:SHELBY
Last Name:CASSO-GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 SW 13TH AVE APT 1617
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2371
Mailing Address - Country:US
Mailing Address - Phone:210-392-3377
Mailing Address - Fax:
Practice Address - Street 1:430 SW 13TH AVE APT 1617
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2371
Practice Address - Country:US
Practice Address - Phone:210-392-3377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60238536207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine