Healthcare Provider Details

I. General information

NPI: 1235183591
Provider Name (Legal Business Name): RONALD A GOODSITE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 E CARONDELET DR
TUCSON AZ
85710-2119
US

IV. Provider business mailing address

6620 E CARONDELET DR
TUCSON AZ
85710-2119
US

V. Phone/Fax

Practice location:
  • Phone: 520-296-3248
  • Fax: 520-296-3249
Mailing address:
  • Phone: 520-296-3248
  • Fax: 520-296-3249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6040
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: