Provider Demographics
NPI:1649454000
Name:GOSEY, JAMES RAGAN JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RAGAN
Last Name:GOSEY
Suffix:JR
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 1:1150 ROBERT BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2005
Mailing Address - Country:US
Mailing Address - Phone:985-646-3662
Mailing Address - Fax:985-646-3691
Practice Address - Street 1:1150 ROBERT BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:985-646-3662
Practice Address - Fax:985-646-3691
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD013546174400000X
LA01354207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0289950001OtherMEDICARE NSC
LA0289950001OtherMEDICARE NSC
LA52015DB91Medicare PIN