Provider Demographics
NPI:1679751606
Name:GOBER, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:GOBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0369
Mailing Address - Country:US
Mailing Address - Phone:706-291-2077
Mailing Address - Fax:706-235-4177
Practice Address - Street 1:901 N BROAD ST NE
Practice Address - Street 2:SUITE 220
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-5201
Practice Address - Country:US
Practice Address - Phone:706-291-2077
Practice Address - Fax:706-235-4177
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0597272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology