Provider Demographics
NPI:1194716456
Name:GOSLINE, SYLVIA K (MD)
Entity type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:K
Last Name:GOSLINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 N RIVER DR
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-8010
Mailing Address - Country:US
Mailing Address - Phone:541-672-5542
Mailing Address - Fax:541-672-7798
Practice Address - Street 1:148 N RIVER DR
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-8010
Practice Address - Country:US
Practice Address - Phone:541-672-5542
Practice Address - Fax:541-672-7798
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD121912085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR4300924-01OtherPREFERRED CHOICE 65
OR081414Medicaid
OR016146000OtherBCBS OF OREGON
OR081414Medicaid
ORC91096Medicare UPIN