MEDICARE: DR. JOHN ELLIS GOBBLE DRPH, RD, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator
2	133V00000X	Registered Dietitian	000543	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013919323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ELLIS GOBBLE DRPH, RD, LD

Provider Business Mailing Address
First Line	:	1463 SW 20TH CT
Second Line	:
City	:	GRESHAM
State	:	OR
Zip	:	97080-9662
Country	:	US
Telephone Number	:	503-652-5070
Fax Number	:	503-652-5080

Provider Business Practice Location Address
First Line	:	6542 SE LAKE RD STE 202C
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-2244
Country	:	US
Telephone Number	:	503-652-5070
Fax Number	:	800-957-1067

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	11/27/2024

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