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NPI Code Detail

MEDICARE: DR. SCOTT T GOODALL M.D.

MEDICARE: DR. SCOTT T GOODALL M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician32996CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2019386OTHERCOKAISER COMMERCIAL NUMBER

General Provider Information

NPI Number : 1134126592
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SCOTT T GOODALL M.D.
Provider Business Mailing Address
First Line : 10350 E DAKOTA AVE
Second Line :
City : DENVER
State : CO
Zip : 80247-1314
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10400 E ALAMEDA AVE
Second Line :
City : DENVER
State : CO
Zip : 80247-5104
Country : US
Telephone Number : 303-338-4545
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2005
Last Update Date : 04/26/2021

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