Basic Information
| Provider Information | |||||||||
| NPI: | 1053570929 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOODELL | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 W GLENDALE ST | ||||||||
| Address2: | |||||||||
| City: | DILLON | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597252419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068393093 | ||||||||
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| Practice Location | |||||||||
| Address1: | 41 BARRETT ST | ||||||||
| Address2: | DILLON COMMUNITY HEALTH CENTER | ||||||||
| City: | DILLON | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597253508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066834440 | ||||||||
| FaxNumber: | 4066831121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2008 | ||||||||
| LastUpdateDate: | 09/09/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 12780 | MT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.