Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | K5969 | TX |
NPI | 1225118573 |
---|---|
Provider Name | John A. Goss |
First Address | Houston, TX 77030-2348 |
Second Address | Houston, TX 77030-2348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 23/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020049095 | RR MEDICARE (01) | |
116597901 | (05) | TX |
116597903 | (05) | TX |
116597904 | CSHCN (01) | TX |
1672009 | (05) | LA |
G09583 | (02) |