Healthcare Provider Details

I. General information

NPI: 1962483438
Provider Name (Legal Business Name): THERESA KELLER GOEBEL D O P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11786 SE FEDERAL HWY
HOBE SOUND FL
33455-5303
US

IV. Provider business mailing address

11786 SE FEDERAL HWY
HOBE SOUND FL
33455-5303
US

V. Phone/Fax

Practice location:
  • Phone: 772-546-4215
  • Fax: 772-546-8741
Mailing address:
  • Phone: 772-546-4215
  • Fax: 772-546-8741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOS8519
License Number StateFL

VIII. Authorized Official

Name: MRS. THERESA KELLER GOEBEL
Title or Position: PRESIDENT
Credential: DO
Phone: 772-546-4215