Provider Demographics
NPI:1063869121
Name:GOFORTH, SARAH ELISE (DO)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ELISE
Last Name:GOFORTH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10623 BELLAIRE BLVD STE C280
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-5242
Mailing Address - Country:US
Mailing Address - Phone:713-486-5900
Mailing Address - Fax:713-486-5901
Practice Address - Street 1:6431 FANNIN ST
Practice Address - Street 2:SUITE MSB 3.151
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-500-5800
Practice Address - Fax:713-500-5805
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS3175208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program