Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | R4553 | TX |
NPI | 1063858272 |
---|---|
Provider Name | Travis Goodale |
First Address | Webster, TX 77598-8538 |
Second Address | Webster, TX 77598 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2013 |
Last Update Date | 17/08/2018 |