Healthcare Provider Details

I. General information

NPI: 1992774574
Provider Name (Legal Business Name): ROBERT BRUCE GOOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4112 OUTLOOK BLVD
PUEBLO CO
81008-1667
US

IV. Provider business mailing address

PO BOX 19803
COLORADO CITY CO
81019-0803
US

V. Phone/Fax

Practice location:
  • Phone: 719-553-1000
  • Fax: 719-553-1107
Mailing address:
  • Phone: 719-676-2730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number31259
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number31259
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: