Healthcare Provider Details

I. General information

NPI: 1952321515
Provider Name (Legal Business Name): RONDAL GOBLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 RICHMOND RD STE 201
LEXINGTON KY
40502-1213
US

IV. Provider business mailing address

4124 BOONE CREEK RD
LEXINGTON KY
40509-9712
US

V. Phone/Fax

Practice location:
  • Phone: 859-227-1251
  • Fax: 859-264-7886
Mailing address:
  • Phone: 859-227-1251
  • Fax: 859-264-7886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number26176
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26176
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: