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NPI Code Detail

MEDICARE: ASHLEY R GOODALL PA

MEDICARE: ASHLEY R GOODALL PA
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
1363A00000XPhysician AssistantPA06124TX

General Provider Information

NPI Number : 1851619605
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY R GOODALL PA
Provider Business Mailing Address
First Line : 5501 GORDON SMITH DR STE 500
Second Line :
City : ROWLETT
State : TX
Zip : 75089-3209
Country : US
Telephone Number : 214-703-8100
Fax Number : 214-703-3269
Provider Business Practice Location Address
First Line : 5501 GORDON SMITH DR STE 500
Second Line :
City : ROWLETT
State : TX
Zip : 75089-3209
Country : US
Telephone Number : 214-703-8100
Fax Number : 214-703-3269
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2010
Last Update Date : 08/04/2010

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Directions to “ ASHLEY R GOODALL PA” Practice Location

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