Provider Demographics
NPI:1205935186
Name:GOEBEL, CHARLES D (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:D
Last Name:GOEBEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4129 STATEN ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3436
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3405 MIDWAY RD
Practice Address - Street 2:SUITE 650
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8138
Practice Address - Country:US
Practice Address - Phone:972-473-7777
Practice Address - Fax:973-473-7780
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5962208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics