Provider Demographics
NPI:1730151101
Name:GOETHE, ROBERT CARL (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CARL
Last Name:GOETHE
Suffix:
Gender:M
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:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34423-0457
Mailing Address - Country:US
Mailing Address - Phone:352-795-4008
Mailing Address - Fax:352-795-9041
Practice Address - Street 1:6201 N SUNCOAST BLVD
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34428-6712
Practice Address - Country:US
Practice Address - Phone:352-795-4008
Practice Address - Fax:352-795-9041
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50717207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08355OtherBLUE CROSS
FL1801801527OtherC.R. ANESTHESIA, P.A.
FL267181600Medicaid
FL08355XMedicare PIN
FL1801801527OtherC.R. ANESTHESIA, P.A.