Individual
TIMOTHY JAMES GOODRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
A.A.
Contact information
Practice address
302 UNIVERSITY BLVD, ROUND ROCK, TX 78665-1032
(512) 509-0200
(512) 218-6330
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
343
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430055881
RAILROAD MEDICARE
TX
Enumeration date
01/30/2007
Last updated
12/16/2021
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