Provider Demographics
NPI:1073587614
Name:GOBAL, FREIJ ANTOINE (MD)
Entity Type:Individual
Prefix:DR
First Name:FREIJ
Middle Name:ANTOINE
Last Name:GOBAL
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 1:11511 CANTERWOOD BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-5817
Mailing Address - Country:US
Mailing Address - Phone:253-627-1244
Mailing Address - Fax:253-530-2933
Practice Address - Street 1:11511 CANTERWOOD BLVD STE 110
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-5817
Practice Address - Country:US
Practice Address - Phone:253-627-1244
Practice Address - Fax:253-530-2933
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060555A207R00000X
ARE-6087207R00000X, 207RC0000X
WAMD60590251207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA356022OtherSTATE L&I
INP00225443OtherRAILROAD MEDICARE
AR185115001Medicaid
IN200527190Medicaid
WA356022OtherSTATE L&I
AR5AE53G466Medicare PIN
IN200527190Medicaid