Provider Demographics
NPI:1760469589
Name:GOEBEL, CHRISTINA (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:GOEBEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5409 AVE O
Mailing Address - Street 2:SUITE126
Mailing Address - City:FORT MADISON
Mailing Address - State:IA
Mailing Address - Zip Code:52627-9601
Mailing Address - Country:US
Mailing Address - Phone:319-372-5925
Mailing Address - Fax:319-372-1381
Practice Address - Street 1:5409 AVE O
Practice Address - Street 2:SUITE126
Practice Address - City:FORT MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627-9601
Practice Address - Country:US
Practice Address - Phone:319-372-5925
Practice Address - Fax:319-372-1381
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA37450207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0420018Medicaid
IAI01362Medicare UPIN
IA0420018Medicaid