Healthcare Provider Details

I. General information

NPI: 1164412300
Provider Name (Legal Business Name): LINDA A GOODRUM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 MEDICAL CENTER BLVD SUITE 300A
WEBSTER TX
77598-4213
US

IV. Provider business mailing address

5124 HIDDEN BROOK LN
LEAGUE CITY TX
77573-5781
US

V. Phone/Fax

Practice location:
  • Phone: 281-338-7693
  • Fax: 281-338-8849
Mailing address:
  • Phone: 281-338-7693
  • Fax: 281-338-8849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberJ4827
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: