Provider Demographics
NPI:1295893188
Name:GOERING, MARCIA LYNNE (MD)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:LYNNE
Last Name:GOERING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2485 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-2256
Mailing Address - Country:US
Mailing Address - Phone:402-564-9575
Mailing Address - Fax:402-562-7472
Practice Address - Street 1:2485 39TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-2256
Practice Address - Country:US
Practice Address - Phone:402-564-9575
Practice Address - Fax:402-562-7472
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18870207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE00334OtherBCBS NE
NE00334OtherBCBS NE
NE270540Medicare ID - Type UnspecifiedMEDICARE