Healthcare Provider Details

I. General information

NPI: 1629394663
Provider Name (Legal Business Name): RANDALL L GOODE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

973 MICA DR
CARSON CITY NV
89705-7255
US

IV. Provider business mailing address

PO BOX 4300 MS 01
PORTLAND OR
97208-4300
US

V. Phone/Fax

Practice location:
  • Phone: 775-267-2992
  • Fax:
Mailing address:
  • Phone: 503-372-2740
  • Fax: 503-372-2755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number8585
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number8585
License Number StateNV

VIII. Authorized Official

Name: DR. RANDALL L GOODE
Title or Position: OWNER
Credential: MD
Phone: 503-372-2740