NPIMap

Organization Active NPI

Southern Medical Associates

  • Internal Medicine Physician
  • Gonzales, LA
National Provider Identifier
1861646739
Registry record updated Nov 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
SOUTHERN MEDICAL ASSOCIATES
Practice address
2524 S. Philippe Avenue
Gonzales, LA 70737
Phone
(225) 644-1990
Fax
(225) 644-3264
NPI assigned
Nov 5, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gertrude Gboloo, MD
Title
Owner
Phone
(225) 644-1990

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X MD.202326 LA
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X LA Primary

Addresses

Primary practice location

2524 S. Philippe Avenue
Gonzales, LA 70737

Mailing address

P.O. Box 1388
Gonzales, LA 70737
Phone (225) 644-1990

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225843200000",
    "number": "1861646739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1388",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "70737",
            "telephone_number": "225-644-1990",
            "fax_number": "225-644-3264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2524 S. PHILIPPE AVENUE",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "70737",
            "telephone_number": "225-644-1990",
            "fax_number": "225-644-3264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MEDICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-05",
        "last_updated": "2008-11-05",
        "status": "A",
        "authorized_official_last_name": "GBOLOO",
        "authorized_official_first_name": "GERTRUDE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "225-644-1990",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "MD.202326",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gonzales, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.