Individual
MARVIN L GOODMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1310 S MAIN ST, GROVE, OK 74344-5304
(918) 786-2243
Mailing address
PO BOX 450816, GROVE, OK 74345-0816
(918) 787-8980
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R0069405
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100789160A
—
OK
Enumeration date
12/28/2005
Last updated
07/01/2008
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