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NPI Code Detail

MEDICARE: DOMINADOR G GOBALEZA III MD

MEDICARE:   DOMINADOR G GOBALEZA III 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
12084P0800XPsychiatry PhysicianD5D218MD

General Provider Information

NPI Number : 1407829153
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOMINADOR G GOBALEZA III MD
Provider Business Mailing Address
First Line : 2817 REILLY ROAD
Second Line : MCXC-COD CREDENTIALS WOMACK ARMY MEDICAL CENTER
City : FORT BRAGG
State : NC
Zip : 28310
Country : US
Telephone Number : 910-907-8922
Fax Number : 910-907-6069
Provider Business Practice Location Address
First Line : 2817 REILLY ROAD DDBH 6 NORTH
Second Line : MCXC-COD CREDENTIALS WOMACK ARMY MEDICAL CENTER
City : FORT BRAGG
State : NC
Zip : 28310
Country : US
Telephone Number : 910-907-6825
Fax Number : 910-907-8521
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2006
Last Update Date : 07/08/2007

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Directions to “ DOMINADOR G GOBALEZA III MD” Practice Location

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