Provider Demographics
NPI:1972760973
Name:GOETCHEUS GEHL, ANN JANELLE
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:JANELLE
Last Name:GOETCHEUS GEHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 E 44TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-4611
Mailing Address - Country:US
Mailing Address - Phone:253-471-4553
Mailing Address - Fax:253-474-5395
Practice Address - Street 1:1019 PACIFIC AVE
Practice Address - Street 2:STE. 300
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4443
Practice Address - Country:US
Practice Address - Phone:253-597-4550
Practice Address - Fax:253-597-4556
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
DCMD037558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program