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Organization

GOODSIDE HEALTH MEDICAL, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GERARDO REYES MD (OWNER)
(281) 203-5006
Entity
Organization

Contact information

Practice address
3300 SOUTHGATE CT SW, STE 183, CEDAR RAPIDS, IA 52404
(281) 203-5006
Mailing address
1701 RIVER RUN STE 302, FORT WORTH, TX 76107-6547
(281) 203-5006

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
207R00000X
Internal Medicine Physician
208000000X
Pediatrics Physician
Primary
261Q00000X
Clinic/Center
261QM1300X
Multi-Specialty Clinic/Center
363A00000X
Physician Assistant
363L00000X
Nurse Practitioner

Other

Enumeration date
06/13/2022
Last updated
07/01/2022
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