=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689971848
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RONALD A GOODSITE, MD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2011
-----------------------------------------------------
Last Update Date | 02/23/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6620 E CARONDELET DR
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85710-2119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-296-3248
-----------------------------------------------------
Fax | 520-296-3249
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6620 E CARONDELET DR
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85710-2119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-296-3248
-----------------------------------------------------
Fax | 520-296-3249
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | RONALD A GOODSITE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 520-296-3248
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 6040
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------