Provider Demographics
NPI:1275515454
Name:GOBER, JOHN R (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:GOBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:503 CLARK ST NE
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-1921
Mailing Address - Country:US
Mailing Address - Phone:256-739-1759
Mailing Address - Fax:256-739-0027
Practice Address - Street 1:1800 AL HIGHWAY 157
Practice Address - Street 2:SUITE 101
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-1271
Practice Address - Country:US
Practice Address - Phone:256-739-4131
Practice Address - Fax:256-739-6027
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL7389207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1164743068Medicaid
AL51026284OtherBCBS OF AL
AL117969Medicaid
AL51026284OtherBCBS OF AL