Healthcare Provider Details

I. General information

NPI: 1174620504
Provider Name (Legal Business Name): ROBERT H. GOEBEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BUCKWALTER PLACE BLVD STE 150
BLUFFTON SC
29910-5023
US

IV. Provider business mailing address

16201 TYPHOON LN
HUNTINGTON BEACH CA
92649-2541
US

V. Phone/Fax

Practice location:
  • Phone: 843-836-7120
  • Fax:
Mailing address:
  • Phone: 714-421-7927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberQ2667
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD182377
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD60457211
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number37612
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG-38910
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number2085R0001X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: