Provider Demographics
NPI:1407950652
Name:GOOCH, SCOTT DAVID (PA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:DAVID
Last Name:GOOCH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MARSHFIELD MEDICAL CENTER- EAU CLAIRE
Mailing Address - Street 2:2116 CRAIG RD
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701
Mailing Address - Country:US
Mailing Address - Phone:715-858-4799
Mailing Address - Fax:
Practice Address - Street 1:MARSHFIELD MEDICAL CENTER- EAU CLAIRE
Practice Address - Street 2:2116 CRAIG RD
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701
Practice Address - Country:US
Practice Address - Phone:715-858-4799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-09
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02927363A00000X
WI1232023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01870Medicare UPIN