Provider Demographics
NPI:1851387302
Name:GOSLING, JOHN R (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:GOSLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3950 HOLLYWOOD RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9159
Mailing Address - Country:US
Mailing Address - Phone:269-983-0500
Mailing Address - Fax:269-429-2240
Practice Address - Street 1:3950 HOLLYWOOD RD
Practice Address - Street 2:SUITE 270
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9159
Practice Address - Country:US
Practice Address - Phone:269-983-0500
Practice Address - Fax:269-429-2240
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2015-02-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301047357207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A78226OtherHAP
19080OtherHPM
4613113OtherAETNA
04827OtherPARAMOUNT
MI1851387302Medicaid
000000376429OtherANTHEM
143555OtherGLHP
P00255318OtherRRMC
101920OtherCARECHOICE/PREFERRED CHOI
MI1109403311OtherBCBS
MI1109403311OtherBCBS
101920OtherCARECHOICE/PREFERRED CHOI