Healthcare Provider Details

I. General information

NPI: 1063669968
Provider Name (Legal Business Name): WILLIAM B GOBLE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 02/20/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 SE TALLGRASS LANE STE 150
WAUKEE IA
50263
US

IV. Provider business mailing address

PO BOX 424
DES MOINES IA
50302-0424
US

V. Phone/Fax

Practice location:
  • Phone: 515-875-8070
  • Fax: 515-875-8071
Mailing address:
  • Phone: 515-875-9925
  • Fax: 515-875-9923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4080
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: