Provider Demographics
NPI:1184692329
Name:JAMES R GOSEY JR. M.D.
Entity type:Organization
Organization Name:JAMES R GOSEY JR. M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADM-M.D.
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOSEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:985-646-3662
Mailing Address - Street 1:1850 GAUSE BLVD E
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5442
Mailing Address - Country:US
Mailing Address - Phone:985-646-3662
Mailing Address - Fax:985-646-3691
Practice Address - Street 1:1850 GAUSE BLVD E
Practice Address - Street 2:SUITE 300
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5442
Practice Address - Country:US
Practice Address - Phone:985-646-3662
Practice Address - Fax:985-646-3691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL013546174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DB91Medicare PIN
LAB63533Medicare UPIN
LA0289950001Medicare NSC