MEDICARE: GARY EDWARD GOFF M.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	207R00000X	Internal Medicine Physician	J6460	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
2	75-2884426	OTHER	TX	TAX ID

General Provider Information

NPI Number	:	1629050521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY EDWARD GOFF M.D.

Provider Business Mailing Address
First Line	:	8440 WALNUT HILL LN STE 420
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-3833
Country	:	US
Telephone Number	:	214-879-9966
Fax Number	:	214-267-8999

Provider Business Practice Location Address
First Line	:	8440 WALNUT HILL LN STE 420
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-3833
Country	:	US
Telephone Number	:	214-879-9966
Fax Number	:	214-267-8999

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	01/09/2014

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