Provider Demographics
NPI:1114959574
Name:GOOCH, ERIK J (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:J
Last Name:GOOCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:ERIK
Other - Middle Name:JASON
Other - Last Name:GOOCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-7981
Practice Address - Fax:352-265-7983
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS88182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30651ZMedicare PIN
FLI47033Medicare UPIN