Doctor Name: | JEFFREY GOGEL |
NPI Number: | 1154311041 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | 0102036933 |
Business Practice Address: | 18250 Forest Rd Suite 1 Forest, VA - 245514055 |
Business Phone Number: | 4343854633 |
Business Fax Number: | 4343854714 |
Mailing Address: | 120 Ivy Lea Dr, FOREST |
State: | VA |
Postal Code: | 245513200 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/24/2005 |
NPI Last Update Date: | 08/23/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 204D00000X |
License Number: | 0102036933 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | VA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Neuromusculoskeletal Medicine & OMM |
Taxonomy Specialization: | |
Taxonomy Definition: |