Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 328121 | LA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 328121 | LA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 328121 | LA |
NPI | 1063922573 |
---|---|
Provider Name | Dr. Mario H Lobao Goncalves |
First Address | Shreveport, LA 71103-4228 |
Second Address | Shreveport, LA 71103-4228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2017 |
Last Update Date | 23/07/2021 |