Doctor Name: | DR. ROBERT VINCENT GOUTHRO |
NPI Number: | 1285752089 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 53075 |
Business Practice Address: | 2680 Vernon Dr Green Bay, WI - 543045374 |
Business Phone Number: | 9204964700 |
Business Fax Number: | |
Mailing Address: | 2680 Vernon Dr, GREEN BAY |
State: | WI |
Postal Code: | 543045374 |
Phone Number: | 9204964700 |
Fax Number: | |
NPI Enumeration Date: | 03/27/2007 |
NPI Last Update Date: | 01/06/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 53075 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |