MEDICARE: DR. DAVID PAUL GOSSE PSY.D.

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	103TC0700X	Clinical Psychologist	PY 0424	NV

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	:	1558456129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID PAUL GOSSE PSY.D.

Provider Business Mailing Address
First Line	:	2100 JETTY ROCK DRIVE
Second Line	:	#103
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-6609
Country	:	US
Telephone Number	:	702-228-8411
Fax Number	:

Provider Business Practice Location Address
First Line	:	2620 REGATTA DRIVE
Second Line	:	SUITE 102
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-6891
Country	:	US
Telephone Number	:	702-385-4673
Fax Number	:	702-925-8261

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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