Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 2016-01101 | NC |
N | 208D00000X | General Practice Physician | 2016-01101 | NC |
NPI | 1003153784 |
---|---|
Provider Name | Sarah Goss |
First Address | Fort Sam Houston, TX 78234-4504 |
Second Address | Fort Sam Houston, TX 78234-4504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2013 |
Last Update Date | 24/08/2020 |