Basic Information
| Provider Information | |||||||||
| NPI: | 1831400126 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOEBEL | ||||||||
| FirstName: | WALTER | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 670 | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977090670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035982000 | ||||||||
| FaxNumber: | 5036390920 | ||||||||
| Practice Location | |||||||||
| Address1: | 13200 SW PACIFIC HWY | ||||||||
| Address2: | |||||||||
| City: | TIGARD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035982000 | ||||||||
| FaxNumber: | 5036390920 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2010 | ||||||||
| LastUpdateDate: | 08/07/2019 | ||||||||
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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 | 207Q00000X | ML60154176 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD164204 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.