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General NPI Number Information
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NPI Number | 1962778621
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Entity Type | Individual
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Provider Name | KIMBERLY DIANNE GOODSPEED MD
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Gender | Female
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 08/06/2018
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Provider Practice Location Address
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Address Line | 1935 MEDICAL DISTRICT DR GRADUATE MEDICAL EDUCATION
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City | DALLAS
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State | TX
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Zip | 75235
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Country | US
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Telephone | 214-456-2735
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Fax |
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Provider Business Mailing Address
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Address Line | 5323 HARRY HINES BLVD
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City | DALLAS
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State | TX
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Zip | 75390-7201
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Country | US
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Telephone | 214-645-0102
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | R3518
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | R3518
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License Number State | TX
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