Organization
SEASONS MEDICAL AESTHETICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN WAYNE GOODYEAR M.D. (OWNER)
(318) 255-3223
Entity
Organization
Contact information
Practice address
411 E VAUGHN AVE, SUITE 201, RUSTON, LA 71270-5972
(318) 255-3223
(318) 255-3181
Mailing address
921 N TRENTON ST, RUSTON, LA 71270-3327
(318) 255-3223
(318) 255-3181
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
201086
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1453331
—
LA
01
—
201086
MEDICAL LICENSE
LA
01
—
5CX71
MEDICARE
LA
Enumeration date
08/05/2007
Last updated
08/05/2007
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