| Deserae J Goble Md Pc | |
|
1451 N 200 E Ste 250 Logan UT 84341-7570 | |
| (435) 363-7853 | |
| (435) 213-3785 |
| Full Name | Deserae J Goble Md Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 1451 N 200 E Ste 250, Logan, Utah |
| Authorized Official Name and Position | Deserae Goble (OWNER) |
| Authorized Official Contact | 4353637853 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Deserae J Goble Md Pc Po Box 5 Millville UT 84326-0005 Ph: (435) 232-4279 | Deserae J Goble Md Pc 1451 N 200 E Ste 250 Logan UT 84341-7570 Ph: (435) 363-7853 |
| NPI Number | 1407232903 |
|---|---|
| Provider Enumeration Date | 08/06/2015 |
| Last Update Date | 08/31/2021 |
| Medicare PECOS PAC ID | 2860708898 |
|---|---|
| Medicare Enrollment ID | O20150904001350 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407232903 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 5010200-1205 (Utah) | Primary |
| Provider Name | Deserae J Goble |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366415770 PECOS PAC ID: 6002830239 Enrollment ID: I20071011000091 |
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