Provider Demographics
NPI:1174620504
Name:GOEBEL, ROBERT H (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:GOEBEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16201 TYPHOON LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-2541
Mailing Address - Country:US
Mailing Address - Phone:714-421-7927
Mailing Address - Fax:
Practice Address - Street 1:100 BUCKWALTER PLACE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-5023
Practice Address - Country:US
Practice Address - Phone:843-836-7120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ26672085R0001X
ORMD1823772085R0001X
WAMD604572112085R0001X
IA376122085R0001X
CAG-38910208D00000X
CA2085R0001X2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC863603Medicaid
CA00G389100Medicaid
CAHG38910EMedicare ID - Type Unspecified
CAHG38910CMedicare ID - Type Unspecified
CAHG38910DMedicare ID - Type Unspecified
CAHG38910FMedicare ID - Type Unspecified
CAHG38910Medicare ID - Type Unspecified