MEDICARE: JENNIFER W GOBEL 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	208000000X	Pediatrics Physician	31085	MN

General Provider Information

NPI Number	:	1932183167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER W GOBEL MD

Provider Business Mailing Address
First Line	:	1880 LIVINGSTON AVE
Second Line	:	STE 102
City	:	SAINT PAUL
State	:	MN
Zip	:	55118-3425
Country	:	US
Telephone Number	:	651-552-7999
Fax Number	:	651-552-0777

Provider Business Practice Location Address
First Line	:	1880 LIVINGSTON AVE
Second Line	:	STE 102
City	:	SAINT PAUL
State	:	MN
Zip	:	55118-3425
Country	:	US
Telephone Number	:	651-552-7999
Fax Number	:	651-552-0777

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

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	07/08/2007

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