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NPI Code Detail

MEDICARE: GERRY GOGNA

MEDICARE: GERRY GOGNA
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
1390200000XStudent in an Organized Health Care Education/Training ProgramOR

General Provider Information

NPI Number : 1568394575
Entity Type Code : Individual
Provider Name (Legal Business Name) : GERRY GOGNA
Provider Business Mailing Address
First Line : 10480 SW EASTRIDGE ST APT 119
Second Line :
City : PORTLAND
State : OR
Zip : 97225-5050
Country : US
Telephone Number : 778-922-3740
Fax Number : 778-922-3740
Provider Business Practice Location Address
First Line : 1750 SW SKYLINE BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97221-2533
Country : US
Telephone Number : 503-894-9630
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2026
Last Update Date : 06/02/2026

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Directions to “ GERRY GOGNA ” Practice Location

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