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Individual
MR. KENNETH D. GOOGE
Active
Individual
MR. KENNETH D. GOOGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2452
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
290140400
—
FL
01
—
P00107882
RAILROAD MEDICARE
—
01
—
Y01EL
BCBS OF FLORIDA
FL
Enumeration date
09/27/2005
Last updated
11/08/2016
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