MEDICARE: CHRISTIAAN HORST GOEBEL DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	8425054-0501	UT

General Provider Information

NPI Number	:	1659683381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAAN HORST GOEBEL DPM

Provider Business Mailing Address
First Line	:	4578 S HIGHLAND DR
Second Line	:	SUITE 380
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4243
Country	:	US
Telephone Number	:	801-274-9060
Fax Number	:	801-274-2126

Provider Business Practice Location Address
First Line	:	4578 S HIGHLAND DR
Second Line	:	SUITE 380
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4243
Country	:	US
Telephone Number	:	801-274-9060
Fax Number	:	801-274-2126

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

Provider Enumeration Date	:	07/10/2010
Last Update Date	:	03/19/2013

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