Individual
SHANE BRENT GOLLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9040 JACKSON AVE, TACOMA, WA 98431-1100
(253) 477-0838
Mailing address
9040 REID ST, JOINT BASE LEWIS MCCHORD, WA 98431-1101
(253) 968-1110
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0101265466
VA
208D00000X
General Practice Physician
0101265466
VA
Other
Enumeration date
04/14/2017
Last updated
10/25/2023
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