Provider Demographics
NPI:1336123165
Name:GOGGIN, ANDREW S (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:S
Last Name:GOGGIN
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 1:308 W COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246
Mailing Address - Country:US
Mailing Address - Phone:618-664-0271
Mailing Address - Fax:618-664-3915
Practice Address - Street 1:308 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246
Practice Address - Country:US
Practice Address - Phone:618-664-0771
Practice Address - Fax:618-664-3915
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108090207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108090-2Medicaid
IL036108090Medicaid
MO1336123165Medicaid
H93441Medicare UPIN
MO1336123165Medicaid
IL036108090-2Medicaid