Provider Demographics
NPI:1265406482
Name:GOSLEN, JUNIUS BLAKE III (MD)
Entity type:Individual
Prefix:DR
First Name:JUNIUS
Middle Name:BLAKE
Last Name:GOSLEN
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:1918 RANDOLPH RD
Mailing Address - Street 2:SUITE 550
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1100
Mailing Address - Country:US
Mailing Address - Phone:704-375-6766
Mailing Address - Fax:704-332-6552
Practice Address - Street 1:1918 RANDOLPH RD
Practice Address - Street 2:SUITE 550
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1100
Practice Address - Country:US
Practice Address - Phone:704-375-6766
Practice Address - Fax:704-332-6552
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-09-06
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Provider Licenses
StateLicense IDTaxonomies
NC18644207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC88102Medicare UPIN