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General NPI Number Information
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NPI Number | 1306841820
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Entity Type | Individual
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Provider Name | TIMOTHY A GOEDDE MD
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Gender | Male
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 7501 PINE ROYAL DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-3264
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Country | US
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Telephone | 317-201-1190
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Fax |
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Provider Business Mailing Address
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Address Line | 7501 PINE ROYAL DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-3264
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 01039996A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 01039996A
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License Number State | IN
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