Individual
MARK A GOFORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
14029 E CAMINO GALANTE, VAIL, AZ 85641-2067
(520) 904-7987
Mailing address
14029 E. CAMINO GALANTE, VAIL, AZ 85641
(520) 904-7987
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP4993
AZ
Other
Enumeration date
01/27/2014
Last updated
08/26/2025
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