Provider Demographics
NPI:1750880134
Name:GENOVESE, ROBERT GOMANN II (PA-C)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:GOMANN
Last Name:GENOVESE
Suffix:II
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:3306 WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6946
Mailing Address - Country:US
Mailing Address - Phone:337-945-4695
Mailing Address - Fax:
Practice Address - Street 1:1233 WAYNE GILMORE CIR STE 250A
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6405
Practice Address - Country:US
Practice Address - Phone:337-948-8556
Practice Address - Fax:337-948-6881
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA307277363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical