Provider Demographics
NPI:1790736445
Name:GOOCH, ALLEN CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:CHRISTOPHER
Last Name:GOOCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2002 HOLIDAY LN
Mailing Address - Street 2:STE 100
Mailing Address - City:FULTON
Mailing Address - State:KY
Mailing Address - Zip Code:42041-8468
Mailing Address - Country:US
Mailing Address - Phone:270-472-8150
Mailing Address - Fax:270-472-8155
Practice Address - Street 1:2002 HOLIDAY LN
Practice Address - Street 2:STE 100
Practice Address - City:FULTON
Practice Address - State:KY
Practice Address - Zip Code:42041-8468
Practice Address - Country:US
Practice Address - Phone:270-472-8150
Practice Address - Fax:270-472-8155
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN10000208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3194557Medicaid
B04608Medicare UPIN
TN3194557Medicaid