MEDICARE: CRAIG W GOODSELL D.O.

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
1	207L00000X	Anesthesiology Physician	02628	KY
2	207L00000X	Anesthesiology Physician	DR.0045552	CO

Other Identifiers

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

General Provider Information

NPI Number	:	1689667420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG W GOODSELL D.O.

Provider Business Mailing Address
First Line	:	10 TOWN PLZ # 407
Second Line	:
City	:	DURANGO
State	:	CO
Zip	:	81301-5104
Country	:	US
Telephone Number	:	719-648-5678
Fax Number	:

Provider Business Practice Location Address
First Line	:	575 RIVERGATE
Second Line	:
City	:	DURANGO
State	:	CO
Zip	:	81301-7487
Country	:	US
Telephone Number	:	719-648-5678
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	02/10/2017

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