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Organization
V RUSSELL GOELLER III MD PA
Active
Organization
V RUSSELL GOELLER III MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTOR RUSSELL GOELLER III DMD (PRESIDENT SECRETARY)
(850) 474-1855
Entity
Organization
Contact information
Practice address
2115 W NINE MILE RD, SUITE 1, PENSACOLA, FL 32534-9470
(850) 474-1855
(850) 478-2845
Mailing address
2115 W NINE MILE RD, SUITE 1, PENSACOLA, FL 32534-9470
(850) 474-1855
(850) 478-2845
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN15157
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54999
BCBS
FL
01
—
781189
UNITED CONCORDIA
PA
Enumeration date
10/02/2006
Last updated
07/22/2008
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