Individual
BLAINE GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1000 W 10TH ST, ROLLA, MO 65401-2905
(573) 458-8899
Mailing address
829 OAK KNOLL RD, ROLLA, MO 65401-4715
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2019012508
MO
Other
Enumeration date
05/20/2019
Last updated
05/20/2019
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