Healthcare Provider Details

I. General information

NPI: 1598873002
Provider Name (Legal Business Name): TIMOTHY JOHN GOC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 N 72 STREET
OMAHA NE
68122
US

IV. Provider business mailing address

3749 N 79TH ST
OMAHA NE
68134
US

V. Phone/Fax

Practice location:
  • Phone: 402-572-2160
  • Fax: 402-334-2849
Mailing address:
  • Phone: 402-651-1781
  • Fax: 402-334-2849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number22312
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: