Individual
DR. TONYA GOODSPEED
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1201 MICHIGAN AVE, SUITE 270, LOGANSPORT, IN 46947-1580
(574) 722-4921
(574) 739-0520
Mailing address
1201 MICHIGAN AVE, SUITE 270, LOGANSPORT, IN 46947-1580
(574) 722-4921
(574) 739-0520
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01052818
IN
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
01052818A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000915720
ANTHEM
IN
05
—
200402320
—
IN
01
—
P01428204
RR MEDICARE
IN
Enumeration date
10/24/2006
Last updated
03/07/2024
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