Provider Demographics
NPI:1659683381
Name:GOEBEL, CHRISTIAAN HORST (DPM)
Entity Type:Individual
Prefix:
First Name:CHRISTIAAN
Middle Name:HORST
Last Name:GOEBEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4578 S HIGHLAND DR
Mailing Address - Street 2:SUITE 380
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4243
Mailing Address - Country:US
Mailing Address - Phone:801-274-9060
Mailing Address - Fax:801-274-2126
Practice Address - Street 1:4578 S HIGHLAND DR
Practice Address - Street 2:SUITE 380
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4243
Practice Address - Country:US
Practice Address - Phone:801-274-9060
Practice Address - Fax:801-274-2126
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8425054-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery