Basic Information
| Provider Information | |||||||||
| NPI: | 1174620504 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOEBEL | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | H. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3070 | ||||||||
| Address2: | |||||||||
| City: | TEXARKANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 755043070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036145355 | ||||||||
| FaxNumber: | 9036145399 | ||||||||
| Practice Location | |||||||||
| Address1: | 12410 E SINTO AVE STE B | ||||||||
| Address2: | SUITE A100 | ||||||||
| City: | SPOKANE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992162280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098382531 | ||||||||
| FaxNumber: | 5097556580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 10/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 2085R0001X | CA | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | MD60457211 | WA | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 37612 | IA | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 208D00000X | G-38910 | CA | N | Allopathic & Osteopathic Physicians | General Practice | 2085R0001X | Q2667 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 00G389100 | 05 | CA | MEDICAID |