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Individual

MADISON GOGEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1025 1ST AVE W, JASPER, IN 47546-3217
(812) 476-7111
(812) 476-7117
Mailing address
PO BOX 21890, BELFAST, ME 04915-4115
(502) 907-0356
(502) 919-9780

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10003404A
IN
363A00000X
Physician Assistant
PA3218
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
300056089
IN
05
7100833000
KY
Enumeration date
10/25/2021
Last updated
02/13/2024
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