Provider Demographics
NPI:1508092487
Name:GOOSS, LAWRENCE WILLIAM IV (DO)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:WILLIAM
Last Name:GOOSS
Suffix:IV
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:14415 JUSTICE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-6908
Mailing Address - Country:US
Mailing Address - Phone:804-594-0125
Mailing Address - Fax:804-594-0126
Practice Address - Street 1:14415 JUSTICE RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-6908
Practice Address - Country:US
Practice Address - Phone:804-594-0125
Practice Address - Fax:804-594-0126
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101018198208600000X
VA0102203274207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery