Individual
DIANNE L GOODALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 CLINIC DR, MADISONVILLE, KY 42431-1661
(270) 825-7200
Mailing address
200 CLINIC DR, MADISONVILLE, KY 42431-1661
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
32926
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000044287
BCBS PROVIDER NUMBER
—
01
—
32926
LICENSE
KY
05
—
64329261
—
KY
Enumeration date
09/16/2006
Last updated
12/03/2020
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