Healthcare Provider Details

I. General information

NPI: 1538895545
Provider Name (Legal Business Name): DR. KEITH GOSS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 E PALMAIRE AVE
PHOENIX AZ
85020-5338
US

IV. Provider business mailing address

908 E PALMAIRE AVE
PHOENIX AZ
85020-5338
US

V. Phone/Fax

Practice location:
  • Phone: 480-326-5674
  • Fax:
Mailing address:
  • Phone: 480-326-5674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: DR. KEITH GOSS
Title or Position: OWNER
Credential: DPM
Phone: 480-326-5674