Individual
MICHAEL J GOLOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1501 NE MEDICAL CENTER DR, BEND, OR 97701-6051
(541) 382-2811
Mailing address
PO BOX 6048, BEND, OR 97708-6048
(541) 382-4900
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA151021
OR
363A00000X
Physician Assistant
PA60011749
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0235225
L&I
WA
05
—
500622507
—
OR
01
—
P01161073
MEDICARE RAILROAD
OR
Enumeration date
05/05/2006
Last updated
01/22/2022
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