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General NPI Number Information
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NPI Number | 1689855926
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Entity Type | Individual
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Provider Name | SUSAN MARY GOODNER MD
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Gender | Female
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 504 C. AVENUE
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City | KALONA
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State | IA
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Zip | 52247-9743
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Country | US
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Telephone | 319-656-4333
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Fax |
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Provider Business Mailing Address
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Address Line | 1518 MULBERRY AVE
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City | MUSCATINE
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State | IA
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Zip | 52761-3433
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Country | US
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Telephone | 563-262-4110
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Fax | 563-264-9195
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 23664
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License Number State | IA
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