Healthcare Provider Details

I. General information

NPI: 1679751606
Provider Name (Legal Business Name): DANIEL GOBER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N BROAD ST NE SUITE 220
ROME GA
30161-5201
US

IV. Provider business mailing address

PO BOX 369
ROME GA
30162-0369
US

V. Phone/Fax

Practice location:
  • Phone: 706-291-2077
  • Fax: 706-235-4177
Mailing address:
  • Phone: 706-291-2077
  • Fax: 706-235-4177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number059727
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: