Organization
SWC RUSTON, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN WAYNE GOODYEAR M.D. (MEDICAL DOCTOR)
(318) 255-3223
Entity
Organization
Contact information
Practice address
1809 NORTHPOINTE LN, SUITE 103, RUSTON, LA 71270-3853
(318) 255-3223
(318) 255-3181
Mailing address
1809 NORTHPOINTE LN, SUITE 103, RUSTON, LA 71270-3853
(318) 255-3223
(318) 255-3181
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
MD.201086
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1453331
—
LA
01
—
1538166970
NPI
—
01
—
MD.201086
STATE MEDICAL LICENSE
LA
Enumeration date
07/31/2012
Last updated
07/31/2012
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