Provider Demographics
NPI:1659301265
Name:GOBER, BRIAN CHARLES (MAT, ATC, NREMT-P)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:CHARLES
Last Name:GOBER
Suffix:
Gender:M
Credentials:MAT, ATC, NREMT-P
Other - Prefix:MR
Other - First Name:BRIAN
Other - Middle Name:CHARLES
Other - Last Name:GOBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAT, ATC, NREMT-P
Mailing Address - Street 1:2481 MIKELL RD
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35079-9003
Mailing Address - Country:US
Mailing Address - Phone:205-229-3287
Mailing Address - Fax:
Practice Address - Street 1:1670 VOLKER HALL
Practice Address - Street 2:L209 UNIVERSITY BLVD
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0001
Practice Address - Country:US
Practice Address - Phone:205-934-5870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9900084146L00000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer