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Organization
WATERLOO MED CO
Active
Organization
WATERLOO MED CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY GOODLOE (CEO)
(512) 767-2074
Entity
Organization
Contact information
Practice address
6800 W GATE BLVD, STE 132-309, AUSTIN, TX 78745-4883
(512) 767-2074
Mailing address
6800 W GATE BLVD, STE 132-309, AUSTIN, TX 78745-4883
(512) 767-2074
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
K5965
TX
Other
Enumeration date
10/23/2010
Last updated
10/29/2010
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