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General NPI Number Information
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NPI Number | 1013919323
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Entity Type | Individual
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Provider Name | JOHN ELLIS GOBBLE DRPH, RD, LD
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Gender | Male
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 6542 SE LAKE RD STE 202C
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City | MILWAUKIE
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State | OR
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Zip | 97222-2244
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Country | US
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Telephone | 503-652-5070
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Fax | 800-957-1067
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Provider Business Mailing Address
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Address Line | 1463 SW 20TH CT
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City | GRESHAM
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State | OR
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Zip | 97080-9662
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Country | US
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Telephone | 503-652-5070
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Fax | 503-652-5080
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 000543
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License Number State | OR
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