Provider Demographics
NPI:1730974247
Name:GOBELY, RANDY C
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:C
Last Name:GOBELY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4064 WESTVILLE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:OH
Mailing Address - Zip Code:44609-9313
Mailing Address - Country:US
Mailing Address - Phone:330-257-1904
Mailing Address - Fax:
Practice Address - Street 1:658 WALNUT ST
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-3261
Practice Address - Country:US
Practice Address - Phone:330-853-9520
Practice Address - Fax:330-853-9520
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist