MEDICARE: JOSEPH S. GOETZ, 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	207W00000X	Ophthalmology Physician	G039888	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G039888	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1518149459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH S. GOETZ, MD

Provider Business Mailing Address
First Line	:	9200 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1319
Country	:	US
Telephone Number	:	310-274-4626
Fax Number	:	310-285-0446

Provider Business Practice Location Address
First Line	:	9200 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1319
Country	:	US
Telephone Number	:	310-274-4626
Fax Number	:	310-285-0446

Authorized Official
Title or Position	:	M.D.
Name	:	JOSEPH S. GOETZ
Credential	:	M.D.
Telephone Number	:	310-274-4626

Provider Enumeration Date	:	12/03/2007
Last Update Date	:	04/08/2008

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