Goble, Deserae Jeanette

Goble, Deserae Jeanette is an individual health care provider with primary practice located at 1451 N 200 E Ste 250 , Logan UT 84341-7570. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Goble, Deserae Jeanette can be contacted via phone (435) 363-7853.

Contact Information

Primary practice address
1451 N 200 E Ste 250 Logan UT 84341-7570
Fax: (435) 213-3785
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X A93148 California
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 5010200-1205 Utah

Profile Details

NPI number 1366415770
LBN Legal business name Goble, Deserae Jeanette
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 8th, 2006
Last updated Aug 31st, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366415770 NPPES
Utah MEDICAID 1366415770

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