Provider Demographics
NPI:1215191028
Name:GOBLE, KIRSTEN BUCK (DO)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:BUCK
Last Name:GOBLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 TANGLEWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:SILVERTHORNE
Mailing Address - State:CO
Mailing Address - Zip Code:80498
Mailing Address - Country:US
Mailing Address - Phone:970-469-1003
Mailing Address - Fax:970-262-2196
Practice Address - Street 1:265 TANGLEWOOD LANE
Practice Address - Street 2:SUITE E-1
Practice Address - City:SILVERTHORNE
Practice Address - State:CO
Practice Address - Zip Code:80498
Practice Address - Country:US
Practice Address - Phone:970-468-1003
Practice Address - Fax:970-262-2196
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4071207Q00000X
CO0052895207Q00000X
IAR8404390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program