MEDICARE: GOBBLE SHULTS & ASSOCIATES INC

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

General Provider Information

NPI Number	:	1275604399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOBBLE SHULTS & ASSOCIATES INC

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	:

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	:	PRESIDENT
Name	:	JOHN ELLIS GOBBLE
Credential	:	DRPH, RDN
Telephone Number	:	503-652-5070

Provider Enumeration Date	:	11/11/2006
Last Update Date	:	01/23/2025

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