Provider Demographics
NPI:1215377874
Name:ROBERT B GOOS
Entity Type:Organization
Organization Name:ROBERT B GOOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:GOOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-543-7889
Mailing Address - Street 1:1115 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2867
Mailing Address - Country:US
Mailing Address - Phone:719-543-7889
Mailing Address - Fax:
Practice Address - Street 1:1115 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2867
Practice Address - Country:US
Practice Address - Phone:719-543-7889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-27
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31259261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health