MEDICARE: DR. PHILIP F GOGEL 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	208D00000X	General Practice Physician	036114471	IL
2	202K00000X	Phlebology Physician	2005037958	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	431941391	OTHER	MO	TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942280797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP F GOGEL M.D.

Provider Business Mailing Address
First Line	:	5203 CHIPPEWA ST
Second Line	:	SUITE 301
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2356
Country	:	US
Telephone Number	:	314-481-5000
Fax Number	:	314-481-3037

Provider Business Practice Location Address
First Line	:	505 BUCKEYE DR
Second Line	:
City	:	TROY
State	:	IL
Zip	:	62294-2315
Country	:	US
Telephone Number	:	314-481-5000
Fax Number	:	314-481-3037

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	02/18/2011

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