Organization
D G RELIABLE ANESTHESIA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DALE A GOODMAN MD (OWNER)
(219) 324-2229
Entity
Organization
Contact information
Practice address
800 LINCOLNWAY, SUITE 301, LA PORTE, IN 46350-3439
(219) 324-2229
(219) 324-2229
Mailing address
800 LINCOLNWAY, SUITE 301, LA PORTE, IN 46350-3439
(219) 324-2229
(219) 324-2229
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
01041200
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100165370
—
IN
Enumeration date
03/07/2008
Last updated
12/09/2009
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