Basic Information
Provider Information
NPI: 1003153784
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GOSS
FirstName: SARAH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3551 ROGER BROOKE DR
Address2:  
City: FORT SAM HOUSTON
State: TX
PostalCode: 782344504
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 3551 ROGER BROOKE DR
Address2:  
City: FORT SAM HOUSTON
State: TX
PostalCode: 782344504
CountryCode: US
TelephoneNumber: 2105399582
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/15/2013
LastUpdateDate: 08/24/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/21/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X2016-01101NCY Allopathic & Osteopathic PhysiciansEmergency Medicine 
208D00000X2016-01101NCN Allopathic & Osteopathic PhysiciansGeneral Practice 

No ID Information.


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