Provider Demographics
NPI:1295713659
Name:GOFF, RICHARD C (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:GOFF
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 1:3031 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-1930
Mailing Address - Country:US
Mailing Address - Phone:850-482-2929
Mailing Address - Fax:850-482-2997
Practice Address - Street 1:3031 6TH ST
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-1930
Practice Address - Country:US
Practice Address - Phone:850-482-2929
Practice Address - Fax:850-482-2997
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044466207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME44466OtherMEDICAL LICENSE
FL044529100Medicaid
FLAG2738346OtherDEA NUMBER
FLAG2738346OtherDEA NUMBER