Provider Demographics
NPI:1477503597
Name:GOCIO, ALLAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:C
Last Name:GOCIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 BUTTERCUP DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2921
Mailing Address - Country:US
Mailing Address - Phone:870-508-7080
Mailing Address - Fax:870-508-7865
Practice Address - Street 1:310 BUTTERCUP DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2921
Practice Address - Country:US
Practice Address - Phone:870-508-7080
Practice Address - Fax:870-508-7865
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-5399207T00000X
KY40812207T00000X
IL036113252207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00912408OtherRAILROAD MEDICARE- NNIKY
AR102485001Medicaid
KY7100009160Medicaid
KYP00912408OtherRAILROAD MEDICARE- NNIKY
ILB90222Medicare UPIN
ILIL1627001Medicare PIN