Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | T2006017133 | MO |
NPI | 1013028745 |
---|---|
Provider Name | Myles Brandon Goble |
First Address | Columbia, MO 65201 |
Second Address | Columbia, MO 65201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 23/09/2013 |