Provider Demographics
NPI:1720141252
Name:GOFF, AMY MARIE (DO)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:GOFF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:937-456-4181
Mailing Address - Fax:937-456-4649
Practice Address - Street 1:550 HALLMARK DR
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-8648
Practice Address - Country:US
Practice Address - Phone:937-456-4181
Practice Address - Fax:937-456-4649
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2959207Q00000X
OH34.013747207Q00000X
CA20A8044207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine