MEDICARE: RONDAL GOBLE 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	207Q00000X	Family Medicine Physician	26176	KY
2	207P00000X	Emergency Medicine Physician	26176	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000360795	OTHER	KY	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952321515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONDAL GOBLE MD

Provider Business Mailing Address
First Line	:	4124 BOONE CREEK RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-9712
Country	:	US
Telephone Number	:	859-227-1251
Fax Number	:	859-264-7886

Provider Business Practice Location Address
First Line	:	2121 RICHMOND RD STE 201
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40502-1213
Country	:	US
Telephone Number	:	859-227-1251
Fax Number	:	859-264-7886

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	08/29/2023

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Directions to “ RONDAL GOBLE MD” Practice Location

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