Provider Demographics
NPI:1386068419
Name:GOERSS, JEAN BOVE (MD MPH)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:BOVE
Last Name:GOERSS
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 HACIENDA WAY
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-1154
Mailing Address - Country:US
Mailing Address - Phone:623-606-8605
Mailing Address - Fax:
Practice Address - Street 1:7101 W BEARDSLEY RD
Practice Address - Street 2:UNIT 741
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5699
Practice Address - Country:US
Practice Address - Phone:623-606-8605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27411202C00000X
MN26949208000000X
WA21748208000000X
CAG133821208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No208000000XAllopathic & Osteopathic PhysiciansPediatrics