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General NPI Number Information
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NPI Number | 1114910072
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Entity Type | Individual
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Provider Name | HAROLD N GOOCH MD
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Gender | Male
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Dates
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Enumeration Date | 08/25/2005
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Last Update Date | 02/05/2008
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Provider Practice Location Address
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Address Line | 12176 SOUTH 1000 EAST
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City | DRAPER
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State | UT
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Zip | 84020
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Country | US
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Telephone | 801-572-3750
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Fax | 801-572-1097
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Provider Business Mailing Address
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Address Line | PO BOX 150610
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City | OGDEN
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State | UT
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Zip | 84415-0610
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Country | US
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Telephone | 801-476-9200
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Fax | 801-476-9208
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1811911205
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License Number State | UT
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