Basic Information
| Provider Information | |||||||||
| NPI: | 1932140092 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOBIN | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | RICHARD | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 DOUG WHITE DR STE 250 | ||||||||
| Address2: | |||||||||
| City: | MYRTLE BEACH | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295724181 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432361950 | ||||||||
| FaxNumber: | 8432361952 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 12TH AVE N | ||||||||
| Address2: | SUITE 160W | ||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591017506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106237850 | ||||||||
| FaxNumber: | 4062378501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 01/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 8728 | MT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 39792 | SC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.