Provider Demographics
NPI:1376777029
Name:RICHARD C. GOFF, M.D.
Entity Type:Organization
Organization Name:RICHARD C. GOFF, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-482-2929
Mailing Address - Street 1:3031 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-1930
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:850-482-2997
Practice Address - Street 1:3031 6TH ST
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-1930
Practice Address - Country:US
Practice Address - Phone:850-482-2929
Practice Address - Fax:850-482-2997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44466207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty