Provider Demographics
NPI:1538321633
Name:GARY E GOFF MD PA
Entity Type:Organization
Organization Name:GARY E GOFF MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-879-9966
Mailing Address - Street 1:5939 HARRY HINES BLVD
Mailing Address - Street 2:SUITE #310 POB II
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6246
Mailing Address - Country:US
Mailing Address - Phone:214-879-9966
Mailing Address - Fax:214-267-8999
Practice Address - Street 1:5939 HARRY HINES BLVD
Practice Address - Street 2:SUITE #310 POB II
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6246
Practice Address - Country:US
Practice Address - Phone:214-879-9966
Practice Address - Fax:214-267-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6460207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135348408Medicaid
TXF88215Medicare UPIN
TX135348408Medicaid