Basic Information
| Provider Information | |||||||||
| NPI: | 1730151101 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOETHE | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | CARL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 457 | ||||||||
| Address2: | |||||||||
| City: | CRYSTAL RIVER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344230457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527954008 | ||||||||
| FaxNumber: | 3527959041 | ||||||||
| Practice Location | |||||||||
| Address1: | 6201 N SUNCOAST BLVD | ||||||||
| Address2: | |||||||||
| City: | CRYSTAL RIVER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344286712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527954008 | ||||||||
| FaxNumber: | 3527959041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2006 | ||||||||
| LastUpdateDate: | 02/23/2010 | ||||||||
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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 | 207L00000X | ME50717 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | ME50717 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 08355 | 01 | FL | BLUE CROSS | OTHER | 1801801527 | 01 | FL | C.R. ANESTHESIA, P.A. | OTHER | 267181600 | 05 | FL | MEDICAID |