Provider Demographics
NPI:1003899881
Name:GOOCH, MARY K (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:GOOCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1169 SOUTHWIND DR
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-2644
Mailing Address - Country:US
Mailing Address - Phone:785-350-4670
Mailing Address - Fax:785-350-4688
Practice Address - Street 1:1169 SOUTHWIND DR
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-2644
Practice Address - Country:US
Practice Address - Phone:785-350-4670
Practice Address - Fax:785-350-4688
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-28298207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100370220EMedicaid
KS100370220EMedicaid
BG5922720OtherDEA
H26940Medicare UPIN