Provider Demographics
NPI:1467470237
Name:GOMBKOTO, LOUIS (PAC)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:GOMBKOTO
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:7101 W ANTHONY RD
Mailing Address - Street 2:#89
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34479-1300
Mailing Address - Country:US
Mailing Address - Phone:305-321-6142
Mailing Address - Fax:727-507-3618
Practice Address - Street 1:1500 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4004
Practice Address - Country:US
Practice Address - Phone:352-351-3407
Practice Address - Fax:352-351-3407
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103606363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant