Provider Demographics
NPI:1013002609
Name:DARREN W GOFF MD PC
Entity Type:Organization
Organization Name:DARREN W GOFF MD PC
Other - Org Name:SHANBOUR & GOFF ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE CORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:405-242-4036
Mailing Address - Street 1:4140 W MEMORIAL RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120
Mailing Address - Country:US
Mailing Address - Phone:405-242-4030
Mailing Address - Fax:405-242-4031
Practice Address - Street 1:4140 W MEMORIAL RD
Practice Address - Street 2:SUITE 215
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120
Practice Address - Country:US
Practice Address - Phone:405-242-4030
Practice Address - Fax:405-242-4031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20279174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK529022250003OtherBLUE CROSS BLUE SHIELD
OK529022250003OtherBLUE CROSS BLUE SHIELD