Healthcare Provider Details

I. General information

NPI: 1710996277
Provider Name (Legal Business Name): PAUL GOEHNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MOWRY AVE
FREMONT CA
94538-1716
US

IV. Provider business mailing address

1000 ATKINSON LN
MENLO PARK CA
94025-6133
US

V. Phone/Fax

Practice location:
  • Phone: 510-797-1111
  • Fax:
Mailing address:
  • Phone: 650-328-4641
  • Fax: 650-321-4494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG58275
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: