Provider Demographics
NPI:1730124975
Name:GOACHER, CYNTHIA LEE (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LEE
Last Name:GOACHER
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 1:549 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513-0000
Mailing Address - Country:US
Mailing Address - Phone:303-651-5100
Mailing Address - Fax:970-532-0608
Practice Address - Street 1:549 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:BERTHOUD
Practice Address - State:CO
Practice Address - Zip Code:80513-0000
Practice Address - Country:US
Practice Address - Phone:303-651-5100
Practice Address - Fax:970-532-0608
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34359207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01343599Medicaid
COC494588Medicare PIN
COCOA101874Medicare PIN
CO805296Medicare ID - Type UnspecifiedMEDICARE
CO01343599Medicaid