Provider Demographics
NPI:1447070263
Name:GOEHRING, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:GOEHRING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17909 BURNSIDE RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-4438
Mailing Address - Country:US
Mailing Address - Phone:605-848-1568
Mailing Address - Fax:
Practice Address - Street 1:17909 BURNSIDE RD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-4438
Practice Address - Country:US
Practice Address - Phone:605-848-1568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD123456207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine