Individual
ANGELIQUE ANNETTE BRANNON-GOEDEKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
733 S FLEISHEL AVE, TYLER, TX 75701-2015
(903) 597-2002
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
MD206338
LA
207V00000X
Obstetrics & Gynecology Physician
Primary
R1181
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1974153
—
LA
01
—
317984YNOH
MEDICARE PTAN
LA
01
—
8GM837
BCBS
TX
Enumeration date
04/16/2009
Last updated
02/06/2017
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