Basic Information
Provider Information
NPI: 1003153784
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GOSS
FirstName: SARAH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
Address2:  
City: TACOMA
State: WA
PostalCode: 984310001
CountryCode: US
TelephoneNumber: 2539683885
FaxNumber:  
Practice Location
Address1: MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
Address2:  
City: TACOMA
State: WA
PostalCode: 984310001
CountryCode: US
TelephoneNumber: 2539683885
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/15/2013
LastUpdateDate: 06/25/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

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

No ID Information.


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