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General NPI Number Information
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NPI Number | 1720469455
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Entity Type | Individual
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Provider Name | MARK STEVEN GOSS DPM
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Gender | Male
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Dates
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Enumeration Date | 06/18/2015
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 1881 W 24TH ST STE C
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City | YUMA
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State | AZ
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Zip | 85364-6298
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Country | US
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Telephone | 928-314-3333
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Fax | 928-314-4333
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Provider Business Mailing Address
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Address Line | 2400 S AVENUE A
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City | YUMA
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State | AZ
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Zip | 85364-7170
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Country | US
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Telephone | 928-344-2000
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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 | 212
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | POD000897
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License Number State | AZ
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