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General NPI Number Information
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NPI Number | 1851402150
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Entity Type | Organization
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Legal Business Name | THOMAS P GOODELL MD PC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3810 GRAND AVENUE SUITE B
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City | LARAMIE
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State | WY
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Zip | 82070
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Country | US
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Telephone | 307-742-9940
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Fax | 307-742-9946
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Provider Business Mailing Address
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Address Line | 3810 GRAND AVENUE SUITE B
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City | LARAMIE
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State | WY
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Zip | 82070
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Country | US
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Telephone | 307-742-9940
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Fax | 307-742-9946
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS PERRY GOODELL
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Credential | MD
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Telephone | 307-742-9940
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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 | 6971A
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License Number State | WY
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