Provider Demographics
NPI:1720469455
Name:GOSS, MARK STEVEN (DPM)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:STEVEN
Last Name:GOSS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2400 S AVENUE A
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7170
Mailing Address - Country:US
Mailing Address - Phone:928-314-3333
Mailing Address - Fax:928-314-4333
Practice Address - Street 1:1881 W 24TH ST STE C
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6298
Practice Address - Country:US
Practice Address - Phone:928-314-3333
Practice Address - Fax:928-314-4333
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN212213ES0103X
AZPOD000897213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery