Provider Demographics
NPI:1285904201
Name:GOBLE, ELISE (MD)
Entity type:Individual
Prefix:DR
First Name:ELISE
Middle Name:
Last Name:GOBLE
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 1:2007 NEW BRUNSWICK DR
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-4012
Mailing Address - Country:US
Mailing Address - Phone:650-341-4336
Mailing Address - Fax:
Practice Address - Street 1:2007 NEW BRUNSWICK DR
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-4012
Practice Address - Country:US
Practice Address - Phone:650-341-4336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGFE5645207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology