Provider Demographics
NPI:1306845474
Name:GOEBEL, DAVID KENDALL (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:KENDALL
Last Name:GOEBEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-4775
Practice Address - Street 1:617 23RD ST
Practice Address - Street 2:SUITE 19
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2845
Practice Address - Country:US
Practice Address - Phone:606-325-2221
Practice Address - Fax:606-324-1326
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.067749207RH0003X
KY26621207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64266216Medicaid
OH0941431Medicaid
E41198Medicare UPIN
KY1520002Medicare PIN