Individual
RICHARD LEE SHOMO
Active
Individual
RICHARD LEE SHOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
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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