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NPI Code Detail

MEDICARE: MR. KENNETH D. GOOGE PA-C

MEDICARE: MR. KENNETH D. GOOGE PA-C
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
1363A00000XPhysician AssistantPA2452FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00107882OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3Y01ELOTHERFLBCBS OF FLORIDA

General Provider Information

NPI Number : 1982690681
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KENNETH D. GOOGE PA-C
Provider Business Mailing Address
First Line : 491 MARINER BLVD
Second Line :
City : SPRING HILL
State : FL
Zip : 34609-5680
Country : US
Telephone Number : 353-515-6000
Fax Number :
Provider Business Practice Location Address
First Line : 605 LAMAR AVENUE
Second Line :
City : BROOKSVILLE
State : FL
Zip : 34601-3211
Country : US
Telephone Number : 352-796-9990
Fax Number : 352-796-2226
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2005
Last Update Date : 11/08/2016

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