Provider Demographics
NPI:1861487977
Name:GOETZ, JOSEPH S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:S
Last Name:GOETZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:S
Other - Last Name:GOETZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77402-0128
Mailing Address - Country:US
Mailing Address - Phone:281-833-3330
Mailing Address - Fax:281-833-3323
Practice Address - Street 1:4660 BEECHNUT ST STE 214
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-1805
Practice Address - Country:US
Practice Address - Phone:713-665-9800
Practice Address - Fax:713-665-9809
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7421207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-3891546OtherTAX IDENTIFICATION NUMBER
TXP00098108OtherMEDICARE RAILROAD
CAG039888OtherMEDICAL LICENSE
CA95-3891546OtherTAX IDENTIFICATION NUMBER
CAWG39888DMedicare PIN
TX8C5889Medicare PIN
TX8C5889Medicare PIN