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Individual

WALTER F GOODWILLIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1700 GEARY ST SE, ALBANY, OR 97322-6842
(541) 812-5500
(541) 812-5584
Mailing address
1700 GEARY ST SE, ALBANY, OR 97322-6842
(541) 812-5500
(541) 812-5584

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
7211
AZ
207Q00000X
Family Medicine Physician
Primary
MD150133
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
203183
AHCCCS ID
AZ
Enumeration date
06/29/2006
Last updated
03/21/2013
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