Provider Demographics
NPI:1629054309
Name:GOSS, STEVEN (PA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:GOSS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11920 S SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-9713
Mailing Address - Country:US
Mailing Address - Phone:559-459-6006
Mailing Address - Fax:
Practice Address - Street 1:2139 E BEECHWOOD AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0340
Practice Address - Country:US
Practice Address - Phone:559-322-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10682363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS97912Medicare UPIN