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General NPI Number Information
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NPI Number | 1700860715
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Entity Type | Individual
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Provider Name | KEITH ALAN GOSS DPM
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Gender | Male
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Dates
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Enumeration Date | 12/02/2005
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Last Update Date | 09/12/2018
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Provider Practice Location Address
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Address Line | 3042 W. QUEEK CREEK RD.
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City | CHANDLER
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State | AZ
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Zip | 85286-0038
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Country | US
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Telephone | 520-796-2600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 38
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City | SACATON
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State | AZ
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Zip | 85147-0001
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Country | US
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Telephone | 602-528-1200
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 0103300903
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License Number State | VA
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