Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD168658 | OR |
Y | 111NI0900X | Internist | MD168658 | OR |
NPI | 1003174632 |
---|---|
Provider Name | Timothy R Gobble |
First Address | Gresham, OR 97080-9662 |
Second Address | Portland, OR 97220-9437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2012 |
Last Update Date | 11/08/2015 |