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NPI Code Detail

MEDICARE: JOHN T GOODSELL DO

MEDICARE: JOHN T GOODSELL DO
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
1207L00000XAnesthesiology Physician554NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811999725
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN T GOODSELL DO
Provider Business Mailing Address
First Line : 9127 W RUSSELL RD STE 110
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-1253
Country : US
Telephone Number : 702-878-0070
Fax Number : 702-209-2064
Provider Business Practice Location Address
First Line : 9127 W RUSSELL RD STE 110
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-1253
Country : US
Telephone Number : 702-878-0070
Fax Number : 702-209-2064
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2005
Last Update Date : 01/11/2018

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Directions to “ JOHN T GOODSELL DO” Practice Location

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