Provider Demographics
NPI:1982662185
Name:GOSS, STEPHEN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LEE
Last Name:GOSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2900 MOBERLY LN
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3748
Mailing Address - Country:US
Mailing Address - Phone:479-273-1550
Mailing Address - Fax:479-273-3330
Practice Address - Street 1:2900 MOBERLY LN
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3748
Practice Address - Country:US
Practice Address - Phone:479-273-1550
Practice Address - Fax:479-273-3330
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6411207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR51943Medicare PIN
AR111700001Medicaid
ARB90230Medicare UPIN