Organization
C STEPHEN GOETZ MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
C STEPHEN GOETZ MD (MEDICAL DOCTOR OWNER)
(916) 966-6444
Entity
Organization
Contact information
Practice address
6401 COYLE AVE, #315, CARMICHAEL, CA 95608-0310
(916) 966-6444
(916) 966-9077
Mailing address
6401 COYLE AVE, #315, CARMICHAEL, CA 95608-0310
(916) 966-6444
(916) 966-9077
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
632226
CA
207ND0900X
Dermatopathology Physician
Primary
632226
CA
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
632226
CA
207NP0225X
Pediatric Dermatology Physician
632226
CA
207NS0135X
Procedural Dermatology Physician
632226
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ06024Z
MEDICARE PTAN
CA
Enumeration date
08/04/2006
Last updated
03/06/2008
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