Provider Demographics
NPI:1467415810
Name:GOETZL, UGO (MD)
Entity Type:Individual
Prefix:
First Name:UGO
Middle Name:
Last Name:GOETZL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1540 SUNDAY DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6000
Mailing Address - Country:US
Mailing Address - Phone:919-782-3456
Mailing Address - Fax:919-582-0528
Practice Address - Street 1:4111 BEN FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2141
Practice Address - Country:US
Practice Address - Phone:919-719-8834
Practice Address - Fax:919-582-0528
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC214022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8936062Medicaid
NCC85675Medicare UPIN
NC8936062Medicaid
NC1467415810Medicare PIN