Healthcare Provider Details

I. General information

NPI: 1366638835
Provider Name (Legal Business Name): THERESA GOEBEL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 07/08/2010
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 Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS8519
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: