1497741151 NPI number — DR. RICHARD M GOEBEL OD

Table of content: DR. RICHARD M GOEBEL OD (NPI 1497741151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497741151 NPI number — DR. RICHARD M GOEBEL OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOEBEL
Provider First Name:
RICHARD
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497741151
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 W 84TH AVE
Provider Second Line Business Mailing Address:
STE 240
Provider Business Mailing Address City Name:
THORNTON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80260-4807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-426-5550
Provider Business Mailing Address Fax Number:
303-426-1180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 W 84TH AVE
Provider Second Line Business Practice Location Address:
STE 240
Provider Business Practice Location Address City Name:
THORNTON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80260-4807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-426-5550
Provider Business Practice Location Address Fax Number:
303-426-1180
Provider Enumeration Date:
09/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPT 813 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 08008138 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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