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General NPI Number Information
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NPI Number | 1598724437
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Entity Type | Individual
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Provider Name | ANTHONY JAY VAN GOOR M.D., MMM, FACP
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Gender | Male
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Dates
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Enumeration Date | 03/20/2006
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Last Update Date | 11/06/2019
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Provider Practice Location Address
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Address Line | 947 MARIANA HILLS CT
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City | LOVELAND
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State | CO
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Zip | 80537-7931
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Country | US
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Telephone | 925-470-7540
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Fax |
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Provider Business Mailing Address
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Address Line | 947 MARIANA HILLS CT
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City | LOVELAND
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State | CO
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Zip | 80537-7931
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Country | US
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Telephone | 925-470-7540
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G87688
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 1432
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License Number State | SD
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