Provider Demographics
NPI:1306908280
Name:DEGOOYER, ROBERT JAMES (NBC HIS)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JAMES
Last Name:DEGOOYER
Suffix:
Gender:M
Credentials:NBC HIS
Other - Prefix:MR
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:DEGOOYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NBC HIS
Mailing Address - Street 1:607 SOUTH CARROLL STREET
Mailing Address - Street 2:P O BOX 243
Mailing Address - City:PARK RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:51246-0243
Mailing Address - Country:US
Mailing Address - Phone:712-472-3698
Mailing Address - Fax:712-472-3698
Practice Address - Street 1:607 SOUTH CARROLL STREET
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:51246-0243
Practice Address - Country:US
Practice Address - Phone:712-472-3698
Practice Address - Fax:712-472-3698
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0035121Medicaid