Provider Demographics
NPI:1275604399
Name:GOBBLE SHULTS & ASSOCIATES INC
Entity Type:Organization
Organization Name:GOBBLE SHULTS & ASSOCIATES INC
Other - Org Name:MEDICAL NUTRITION THERAPY NORTHWEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:GOBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DRPH, RD
Authorized Official - Phone:503-652-5070
Mailing Address - Street 1:1463 SW 20TH CT
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-9662
Mailing Address - Country:US
Mailing Address - Phone:503-652-5070
Mailing Address - Fax:
Practice Address - Street 1:8800 SE SUNNYSIDE RD
Practice Address - Street 2:SUITE 224-SOUTH
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5738
Practice Address - Country:US
Practice Address - Phone:503-652-5070
Practice Address - Fax:800-957-1067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-11
Last Update Date:2018-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR112848Medicare PIN