Individual
JAN BARRY GOOSSENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1400 N 500 E, LOGAN, UT 84341-2455
(435) 716-1000
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(435) 716-1000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
10886108-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110225752
RR MEDICARE PIN
NY
01
—
CC8362
RR MEDICARE GROUP
NY
01
—
GU040042
MEDICARE GROUP
PA
Enumeration date
11/30/2005
Last updated
04/26/2019
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