Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 0401411538 | VA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 3585 | WV |
N | 204E00000X | Oral & Maxillofacial Surgeon | 0401411538 | VA |
N | 204E00000X | Oral & Maxillofacial Surgeon | 3585 | WV |
NPI | 1336260843 |
---|---|
Provider Name | Dr. Michael Timothy Gocke |
First Address | Pittsburgh, PA 15264-5205 |
Second Address | Mclean, VA 22102-2814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 12/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9200594 | (05) | VA |