Individual
TIMOTHY A GOEDDE
Active
Individual
TIMOTHY A GOEDDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01039996A
IN
2086X0206X
Surgical Oncology Physician
Primary
01039996A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000775120
ANTHEM
IN
05
—
100441710
—
IN
01
—
4258887
AETNA
IN
01
—
P01347706
MEDICARE RR PTAN
IN
Enumeration date
06/21/2005
Last updated
01/02/2025
Update your record
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