Individual
RICHARD LEE SHOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2300 GENERAL MEYER AVE, BLDG H100, NEW ORLEANS, LA 70142-0001
(504) 678-8148
(504) 678-1596
Mailing address
1009 DEBORAH DR, SLIDELL, LA 70461-5368
(504) 678-8148
(504) 678-1596
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA04261
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1037052
—
LA
01
—
1049767
NATIONAL CERTIFICATION
—
01
—
PA04261
LICENSE
TX
01
—
PA200160
LICENSE
LA
Enumeration date
12/29/2005
Last updated
06/04/2008
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