MEDICARE: DR. KIMBERLY K GOOCH 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	207R00000X	Internal Medicine Physician	11474	ME

General Provider Information

NPI Number	:	1659365641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY K GOOCH MD

Provider Business Mailing Address
First Line	:	115 MT BLUE CIR
Second Line	:
City	:	FARMINGTON
State	:	ME
Zip	:	04938-6239
Country	:	US
Telephone Number	:	207-778-9664
Fax Number	:	207-778-5913

Provider Business Practice Location Address
First Line	:	115 MT BLUE CIR
Second Line	:
City	:	FARMINGTON
State	:	ME
Zip	:	04938-6239
Country	:	US
Telephone Number	:	207-778-9664
Fax Number	:	207-778-5913

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

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	08/06/2007

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