Provider Demographics
NPI:1356547038
Name:GOSS, SEYMOUR A (MD)
Entity type:Individual
Prefix:
First Name:SEYMOUR
Middle Name:A
Last Name:GOSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 W ORANGE AVE
Mailing Address - Street 2:DEFUNIAK DFS WALK IN CLINIC
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32435-2301
Mailing Address - Country:US
Mailing Address - Phone:850-951-1800
Mailing Address - Fax:850-951-1800
Practice Address - Street 1:9 W ORANGE AVE
Practice Address - Street 2:DFS WALK IN CLINIC
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435-2301
Practice Address - Country:US
Practice Address - Phone:850-951-1800
Practice Address - Fax:850-951-1800
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME17998208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice