Provider Demographics
NPI:1417935511
Name:GOOCH, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:GOOCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:43309 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-6221
Mailing Address - Country:US
Mailing Address - Phone:727-938-2020
Mailing Address - Fax:
Practice Address - Street 1:2955 BROWNWOOD BLVD STE 303
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-2040
Practice Address - Country:US
Practice Address - Phone:352-350-8484
Practice Address - Fax:352-751-9850
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30264207W00000X
FLME123220207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100286250Medicaid
KYK124720Medicare PIN