Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 58860 | AZ |
N | 207L00000X | Anesthesiologist | MD188830 | OR |
NPI | 1013351832 |
---|---|
Provider Name | Heather Goodly |
First Address | Phoenix, AZ 85012-1351 |
Second Address | Phoenix, AZ 85012-1351 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2013 |
Last Update Date | 16/12/2019 |