Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 34007211G | OH |
N | 207QS0010X | Family Doctor - Sports Medicine | 34007211 | OH |
Y | 2081S0010X | Sports Medicine | 34-00-7211 | OH |
Y | 213ES0000X | Sports Medicine | 34-00-7211 | OH |
NPI | 1457325052 |
---|---|
Provider Name | Mr. James D Goff |
First Address | Dover, OH 44622 |
Second Address | Dover, OH 44622 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 05/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2157366 | GROUP MEDICAID (01) | OH |
2436144 | (05) | OH |
H97613 | (02) | OH |