Provider Demographics
NPI:1801183744
Name:GOOCH, DAVID WAYNE (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WAYNE
Last Name:GOOCH
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 1:6565 E CARONDELET DR
Mailing Address - Street 2:#385
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2157
Mailing Address - Country:US
Mailing Address - Phone:520-326-5666
Mailing Address - Fax:
Practice Address - Street 1:6565 E CARONDELET DR # 385
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2117
Practice Address - Country:US
Practice Address - Phone:520-326-5666
Practice Address - Fax:520-382-0658
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0785213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery