Provider Demographics
NPI:1366509978
Name:GOETZ, GEORGE SIMON (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:SIMON
Last Name:GOETZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2831
Mailing Address - Street 2:WEST VIRGINIA GASTROENTEROLOGY & ENDOSCOPY
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-2831
Mailing Address - Country:US
Mailing Address - Phone:304-637-2360
Mailing Address - Fax:304-637-2362
Practice Address - Street 1:90 N 4TH ST
Practice Address - Street 2:SUITE 300N
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935-1648
Practice Address - Country:US
Practice Address - Phone:740-633-4765
Practice Address - Fax:740-633-6450
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047428207RG0100X
WV24647207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200264500AMedicaid
WV3810021993Medicaid
WVWV0753AMedicare Oscar/Certification
IN147690BMedicare ID - Type Unspecified
IN200264500AMedicaid