Healthcare Provider Details

I. General information

NPI: 1669040309
Provider Name (Legal Business Name): ALEXANDER GOODSETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 FANNIN ST STE 1700
HOUSTON TX
77030-1526
US

IV. Provider business mailing address

1153 CASTLE BLUFF CIR
WACO TX
76712-7565
US

V. Phone/Fax

Practice location:
  • Phone: 713-486-5527
  • Fax:
Mailing address:
  • Phone: 254-749-8635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP20096354
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: