Basic Information
| Provider Information | |||||||||
| NPI: | 1013028745 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOBLE | ||||||||
| FirstName: | MYLES | ||||||||
| MiddleName: | BRANDON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 N. KEENE STREET | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738822259 | ||||||||
| FaxNumber: | 5738848526 | ||||||||
| Practice Location | |||||||||
| Address1: | 525 N. KEENE STREET | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738822260 | ||||||||
| FaxNumber: | 5738844249 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 09/23/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | T2006017133 | MO | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.