Provider Demographics
NPI:1447205000
Name:GOSE, DAVID L (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:GOSE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4441 CAPITAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-9359
Mailing Address - Country:US
Mailing Address - Phone:269-788-6888
Mailing Address - Fax:269-788-6889
Practice Address - Street 1:4441 CAPITAL AVE SW
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-9359
Practice Address - Country:US
Practice Address - Phone:269-788-6888
Practice Address - Fax:269-788-6889
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085-002697363A00000X
MI5601006293363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant