Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 0102036933 | VA |
N | 207Q00000X | Family Doctor | 0102036933 | VA |
NPI | 1154311041 |
---|---|
Provider Name | Jeffrey Gogel |
First Address | Forest, VA 24551-3200 |
Second Address | Forest, VA 24551-4055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 23/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
282472 | BLUE CROSS/BLUE SHIELD (01) | VA |
541714597 | COMMERCIAL (01) | VA |
541714597 | TRICARE (01) | VA |
E46897 | (02) | VA |