MEDICARE: LAURA MAURER GOODELL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	J3352	TX

General Provider Information

NPI Number	:	1164495677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MAURER GOODELL M.D.

Provider Business Mailing Address
First Line	:	2100 W WILLIAM CANNON DR STE C
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-4869
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 W DEAN KEETON ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78712-1091
Country	:	US
Telephone Number	:	512-471-4955
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	04/24/2023

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