Healthcare Provider Details

I. General information

NPI: 1003051657
Provider Name (Legal Business Name): MARSHA E GOODHEAD MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 S MARYLAND PKWY SUITE 205
LAS VEGAS NV
89109-2441
US

IV. Provider business mailing address

3201 S MARYLAND PKWY SUITE 205
LAS VEGAS NV
89109-2441
US

V. Phone/Fax

Practice location:
  • Phone: 702-731-4215
  • Fax: 702-369-9843
Mailing address:
  • Phone: 702-731-4215
  • Fax: 702-369-9843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4023
License Number StateNV

VIII. Authorized Official

Name: SHARLENE L SCHENCKE
Title or Position: OFFICE MANAGER
Credential:
Phone: 702-731-4215