Healthcare Provider Details

I. General information

NPI: 1790435568
Provider Name (Legal Business Name): CATHERINE ANNE GOETZ DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 MC CLELLAND BLVD
JOPLIN MO
64804-3524
US

IV. Provider business mailing address

PO BOX 3810
JOPLIN MO
64803-3810
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-6625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number2026039685
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: