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Individual

DESERAE JEANETTE GOBLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1451 N 200 E STE 250, LOGAN, UT 84341-7570
(435) 363-7853
(435) 213-3785
Mailing address
1950 S HIGHWAY 89, PERRY, UT 84302-4119
(435) 363-7853
(435) 213-3785

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5010200-1205
UT
207Q00000X
Family Medicine Physician
A93148
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1366415770
UT
Enumeration date
02/08/2006
Last updated
08/31/2021
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