Individual
MR. CHARLES MICHAEL GOEDECKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSA
Contact information
Practice address
16100 SH 288, PEARLAND, TX 77584
(210) 445-9456
Mailing address
1103 HAYLOFT LN, SAN ANTONIO, TX 78245-1456
(210) 445-9456
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
10/10/2016
Last updated
10/08/2021
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