MEDICARE: DR. MONTY LEE GOHL MD

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	208600000X	Surgery Physician	E5762	TX

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	:	1376541219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONTY LEE GOHL MD

Provider Business Mailing Address
First Line	:	PO BOX 938
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76540-0938
Country	:	US
Telephone Number	:	254-634-6999
Fax Number	:	254-200-4099

Provider Business Practice Location Address
First Line	:	2300 S CLEAR CREEK RD
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76549-4984
Country	:	US
Telephone Number	:	254-634-2857
Fax Number	:	254-634-8818

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	03/06/2012

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