Healthcare Provider Details

I. General information

NPI: 1013919323
Provider Name (Legal Business Name): JOHN ELLIS GOBBLE DRPH, RD, LD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6542 SE LAKE RD STE 202C
MILWAUKIE OR
97222-2244
US

IV. Provider business mailing address

1463 SW 20TH CT
GRESHAM OR
97080-9662
US

V. Phone/Fax

Practice location:
  • Phone: 503-652-5070
  • Fax: 800-957-1067
Mailing address:
  • Phone: 503-652-5070
  • Fax: 503-652-5080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000543
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: