Healthcare Provider Details

I. General information

NPI: 1114910072
Provider Name (Legal Business Name): HAROLD N GOOCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12176 SOUTH 1000 EAST
DRAPER UT
84020
US

IV. Provider business mailing address

PO BOX 150610
OGDEN UT
84415-0610
US

V. Phone/Fax

Practice location:
  • Phone: 801-572-3750
  • Fax: 801-572-1097
Mailing address:
  • Phone: 801-476-9200
  • Fax: 801-476-9208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1811911205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: