Provider Demographics
NPI:1932541307
Name:GOEBEL, LANCE (MD , PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:
Last Name:GOEBEL
Suffix:
Gender:M
Credentials:MD , PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 NEWTON LN
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6353
Mailing Address - Country:US
Mailing Address - Phone:559-356-4442
Mailing Address - Fax:
Practice Address - Street 1:141 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-1714
Practice Address - Country:US
Practice Address - Phone:559-356-4442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN57996207R00000X
CA48201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No183500000XPharmacy Service ProvidersPharmacist