Individual
JEFFREY GOGEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
18250 FOREST RD, SUITE 1, FOREST, VA 24551-4055
(434) 385-4633
(434) 385-4714
Mailing address
120 IVY LEA DR, FOREST, VA 24551-3200
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
0102036933
VA
207Q00000X
Family Medicine Physician
0102036933
VA
208VP0000X
Pain Medicine Physician
Primary
0102036933
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
282472
BLUE CROSS/BLUE SHIELD
VA
01
—
541714597
TRICARE
VA
Enumeration date
10/24/2005
Last updated
08/23/2010
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