Organization
SOUTHERN MEDICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERTRUDE GBOLOO MD (OWNER)
(225) 644-1990
Entity
Organization
Contact information
Practice address
2524 S. PHILIPPE AVENUE, GONZALES, LA 70737
(225) 644-1990
(225) 644-3264
Mailing address
P.O. BOX 1388, GONZALES, LA 70737
(225) 644-1990
(225) 644-3264
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD.202326
LA
207R00000X
Internal Medicine Physician
Primary
—
LA
Other
Enumeration date
11/05/2008
Last updated
11/05/2008
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