| Brian Gamborg, | |
|
1525 Oak Park Blvd, Lake Charles, LA 70601-8849 | |
| (337) 494-6767 | |
| (337) 494-6750 |
| Full Name | Brian Gamborg |
|---|---|
| Gender | Male |
| Speciality | Family Practice |
| Experience | 41 Years |
| Location | 1525 Oak Park Blvd, Lake Charles, Louisiana |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295795755 | NPI | - | NPPES |
| 1694878 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 023359 (Louisiana) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| West Calcasieu Cameron Hospital | Sulphur, LA | Hospital |
| Lake Charles Memorial Hospital | Lake charles, LA | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Lsuhsc Family Practice Center @ Lcmh | 0042297558 | 8 |
| Calcasieu Cameron Hospital Medicine Group Llc | 1557688421 | 58 |
| Entity Name | Lsuhsc Family Practice Center @ Lcmh |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1073514493 PECOS PAC ID: 0042297558 Enrollment ID: O20040702000045 |
| Entity Name | Calcasieu Cameron Hospital Medicine Group Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1659764967 PECOS PAC ID: 1557688421 Enrollment ID: O20150402002192 |
| Mailing Address | Practice Location Address |
|---|---|
| Brian Gamborg, Po Box 123453 Dept 3453, Dallas, TX 75312-3453 Ph: (337) 494-2921 | Brian Gamborg, 1525 Oak Park Blvd, Lake Charles, LA 70601-8849 Ph: (337) 494-6767 |
Dr. Benjamin Bryce Williams, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 771 E Bayou Pines Dr, Lake Charles, LA 70601 Phone: 337-433-1212 Fax: 337-433-0736 | |
Dr. Michael Kevin Seep, M.D. Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 2750 Aster St, Lake Charles, LA 70601 Phone: 337-480-8900 Fax: 337-480-8901 | |
Dr. Melissa Lalande Rasberry, M.D. Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 1920 W Sale Rd, Bldg F, Suite 2, Lake Charles, LA 70605 Phone: 337-474-2856 Fax: 337-480-0645 | |
Micah Leleux, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 217 Sam Houston Jones Pkwy Ste 104, Lake Charles, LA 70611 Phone: 337-480-8989 Fax: 337-480-8988 | |
Kira Racine Groves, DO Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 2750 Aster St, Lake Charles, LA 70601 Phone: 337-480-8900 Fax: 337-480-8901 | |
Dr. Jason P Hagen, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 1000 Walters St, Lake Charles, LA 70607 Phone: 337-480-8066 Fax: 337-480-8061 | |
Elvira Delbar Kazemyan, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 1525 Oak Park Blvd, Lake Charles, LA 70601 Phone: 337-494-2023 Fax: 337-630-6966 |