Provider Demographics
NPI:1598764102
Name:GOZAINE, TEOFILO (MD)
Entity Type:Individual
Prefix:
First Name:TEOFILO
Middle Name:
Last Name:GOZAINE
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 1:506 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4482
Mailing Address - Country:US
Mailing Address - Phone:337-239-2234
Mailing Address - Fax:337-239-2238
Practice Address - Street 1:506 S 6TH ST
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4442
Practice Address - Country:US
Practice Address - Phone:337-239-2234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15440R207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1461334Medicaid
LA1461334Medicaid
LA$$$$$$$$$0OtherBCBS
LA1461334Medicaid
LA4J024D639Medicare PIN