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NPI Code Detail

MEDICARE: M. DOUGLAS GOSSMAN, MD, PLLC

MEDICARE: M. DOUGLAS GOSSMAN, MD, PLLC
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
1207W00000XOphthalmology Physician21642KY

General Provider Information

NPI Number : 1093998171
Entity Type Code : Organization
Provider Name (Legal Business Name) : M. DOUGLAS GOSSMAN, MD, PLLC
Provider Business Mailing Address
First Line : 2302 HURSTBOURNE VILLAGE DR STE 700
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-1878
Country : US
Telephone Number : 502-495-2122
Fax Number : 502-719-0146
Provider Business Practice Location Address
First Line : 2302 HURSTBOURNE VILLAGE DR STE 700
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-1878
Country : US
Telephone Number : 502-495-2122
Fax Number : 502-719-0146
Authorized Official
Title or Position : PHYSICIAN/OWNER
Name : M DOUGLAS GOSSMAN
Credential : MD
Telephone Number : 502-495-2122
Provider Enumeration Date : 12/11/2007
Last Update Date : 12/11/2007

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