Provider Demographics
NPI:1952321515
Name:GOBLE, RONDAL (MD)
Entity Type:Individual
Prefix:
First Name:RONDAL
Middle Name:
Last Name:GOBLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4124 BOONE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-9712
Mailing Address - Country:US
Mailing Address - Phone:859-227-1251
Mailing Address - Fax:859-264-7886
Practice Address - Street 1:2121 RICHMOND RD STE 201
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-1213
Practice Address - Country:US
Practice Address - Phone:859-227-1251
Practice Address - Fax:859-264-7886
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26176207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000360795OtherANTHEM
KY7100152730Medicaid
KYC69225Medicare UPIN
KY7100152730Medicaid
0549110Medicare PIN
0549031Medicare PIN
0664912Medicare PIN
KYP400029060Medicare PIN
3331062Medicare PIN
KYP400029060Medicare PIN