=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043208648
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES A GOEKEN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2005
-----------------------------------------------------
Last Update Date | 12/18/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 HAWKINS DR
-----------------------------------------------------
City | IOWA CITY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52242-1009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-356-1966
-----------------------------------------------------
Fax | 319-384-8053
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 HAWKINS DR
-----------------------------------------------------
City | IOWA CITY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52242-1009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-356-1966
-----------------------------------------------------
Fax | 319-384-8053
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZI0100X
-----------------------------------------------------
Taxonomy Name | Immunopathology Physician
-----------------------------------------------------
License Number | 19093
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | 19093
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------