Provider Demographics
NPI:1730144718
Name:GOEN, PAUL SCOTT (M D)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:SCOTT
Last Name:GOEN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10525
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77842-0525
Mailing Address - Country:US
Mailing Address - Phone:979-426-4325
Mailing Address - Fax:979-810-0191
Practice Address - Street 1:1512 HOLLEMAN DR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-3297
Practice Address - Country:US
Practice Address - Phone:979-426-4325
Practice Address - Fax:979-810-0191
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2330207PE0005X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8U1464OtherBLUE SHIELD
TX8G0689Medicare ID - Type Unspecified
TX8U1464OtherBLUE SHIELD