Individual
DR. GLENN MARK GOMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10310 THE GROVE BLVD, BATON ROUGE, LA 70836-6455
(225) 761-5200
(225) 761-5711
Mailing address
10310 THE GROVE BLVD, BATON ROUGE, LA 70836-6455
(225) 761-5200
(225) 761-5711
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
015674
LA
207RP1001X
Pulmonary Disease Physician
Primary
15674
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1312037
—
LA
Enumeration date
07/12/2006
Last updated
06/13/2019
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