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Individual
GABRIELLE GOODRICK
Active
Individual
GABRIELLE GOODRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22811
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0899222
AETNA
AZ
01
—
815204
HUMANA
AZ
01
—
86-0937180
TAX ID #
AZ
01
—
AZ0836190
BCBS
AZ
Enumeration date
05/16/2006
Last updated
10/12/2016
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