Provider Demographics
NPI:1053658385
Name:GOHEEN, DAVID CLEMENT (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CLEMENT
Last Name:GOHEEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POB 412
Mailing Address - Street 2:
Mailing Address - City:THE SEA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:95497-0412
Mailing Address - Country:US
Mailing Address - Phone:707-785-9170
Mailing Address - Fax:
Practice Address - Street 1:370 LONGMEADOW ROAD
Practice Address - Street 2:
Practice Address - City:THE SEA RANCH
Practice Address - State:CA
Practice Address - Zip Code:95497-0412
Practice Address - Country:US
Practice Address - Phone:707-785-9170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG027359207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG027359OtherSTATE OF CALIFORNIA