Individual
DALE A. GOODMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1007 LINCOLNWAY, LA PORTE, IN 46350-3201
(219) 326-1234
Mailing address
800 LINCOLNWAY, SUITE 301, LA PORTE, IN 46350-3438
(219) 324-2229
(219) 324-2229
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01041200
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000191669
ANTHEM PROVIDER NUMBER
IN
01
—
050027208
RAILROAD PROVIDER NUMBER
IN
05
—
100165370A
—
IN
Enumeration date
10/03/2006
Last updated
06/22/2009
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