Healthcare Provider Details

I. General information

NPI: 1851398150
Provider Name (Legal Business Name): PAUL J GOEBEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6327 N FRESNO ST SUITE 104
FRESNO CA
93710-5236
US

IV. Provider business mailing address

6327 N FRESNO ST SUITE 104
FRESNO CA
93710-5236
US

V. Phone/Fax

Practice location:
  • Phone: 559-431-4020
  • Fax: 559-431-4589
Mailing address:
  • Phone: 559-431-4020
  • Fax: 559-431-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG478690
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: