Provider Demographics
NPI:1215099627
Name:GOOCH, RITCHIE B (MD)
Entity type:Individual
Prefix:DR
First Name:RITCHIE
Middle Name:B
Last Name:GOOCH
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 1:1377 N 10TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383
Mailing Address - Country:US
Mailing Address - Phone:503-769-7771
Mailing Address - Fax:503-769-4630
Practice Address - Street 1:1377 N 10TH AVENUE
Practice Address - Street 2:
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383
Practice Address - Country:US
Practice Address - Phone:503-769-7771
Practice Address - Fax:503-769-4630
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD11706207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR075119Medicaid
OR075119Medicaid
C92737Medicare UPIN