Healthcare Provider Details

I. General information

NPI: 1164415576
Provider Name (Legal Business Name): KEVIN MATTHEW GOOCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 HOSPITAL RD
WHITESBURG KY
41858-7627
US

IV. Provider business mailing address

214 HOSPITAL RD
WHITESBURG KY
41858-7627
US

V. Phone/Fax

Practice location:
  • Phone: 606-633-3631
  • Fax: 606-633-3204
Mailing address:
  • Phone: 606-633-3631
  • Fax: 606-633-3204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number33188
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: