Healthcare Provider Details

I. General information

NPI: 1841293214
Provider Name (Legal Business Name): JAY B. GOOZE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 GONIC RD
ROCHESTER NH
03867-3926
US

IV. Provider business mailing address

21 GONIC RD
ROCHESTER NH
03867-3926
US

V. Phone/Fax

Practice location:
  • Phone: 603-332-3302
  • Fax: 603-332-9608
Mailing address:
  • Phone: 603-332-3302
  • Fax: 603-332-9608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number5784
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: