Individual
DR. KENNETH L GOOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 264-6000
(601) 579-5240
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 264-6000
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
12115
MS
207Q00000X
Family Medicine Physician
Primary
12115
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00111737
—
MS
01
—
5360131
AETNA
MS
Enumeration date
07/29/2006
Last updated
05/04/2021
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