MEDICARE: DR. ARCHANA GUPTA GOEL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME73785	FL
2	207RR0500X	Rheumatology Physician	ME73785	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215998513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARCHANA GUPTA GOEL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 45443
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84145-0443
Country	:	US
Telephone Number	:	904-202-1032
Fax Number	:	904-376-4107

Provider Business Practice Location Address
First Line	:	1660 PRUDENTIAL DR
Second Line	:	SUITE 310
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8197
Country	:	US
Telephone Number	:	904-396-8656
Fax Number	:	904-396-5931

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	12/18/2018

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Directions to “ DR. ARCHANA GUPTA GOEL M.D.” Practice Location

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