Provider Demographics
NPI:1851607287
Name:JEFFREY B. GOGEL, D.O. P.C.
Entity Type:Organization
Organization Name:JEFFREY B. GOGEL, D.O. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:434-385-4633
Mailing Address - Street 1:18250 FOREST RD STE 1
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4688
Mailing Address - Country:US
Mailing Address - Phone:434-385-4633
Mailing Address - Fax:434-385-4633
Practice Address - Street 1:18250 FOREST RD STE 1
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-4688
Practice Address - Country:US
Practice Address - Phone:434-385-4633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102036933208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty