Provider Demographics
NPI:1255755492
Name:GOCHNOUR, JOSEPH ROBERT (MED, RDN, LD, CPT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ROBERT
Last Name:GOCHNOUR
Suffix:
Gender:M
Credentials:MED, RDN, LD, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 N LAMAR BLVD UNIT 211
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-4938
Mailing Address - Country:US
Mailing Address - Phone:281-757-8139
Mailing Address - Fax:888-965-4398
Practice Address - Street 1:2205 N LAMAR BLVD UNIT 211
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-4938
Practice Address - Country:US
Practice Address - Phone:281-757-8139
Practice Address - Fax:888-965-4398
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83081133VN1201X, 133VN1501X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3689366Medicaid