Healthcare Provider Details

I. General information

NPI: 1053842054
Provider Name (Legal Business Name): PETER HASSRICK GOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 DELAWARE ST
LONGVIEW WA
98632-2367
US

IV. Provider business mailing address

1615 DELAWARE ST
LONGVIEW WA
98632-2367
US

V. Phone/Fax

Practice location:
  • Phone: 360-414-7878
  • Fax: 360-414-7876
Mailing address:
  • Phone: 360-636-4841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD61314524
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: