Organization
ANESTHESIA ASSOCIATES OF GRAND LAKE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARVIN LEE GOODMAN CRNA (MANAGER AND MEMBER)
(918) 787-8980
Entity
Organization
Contact information
Practice address
1001 E 18TH ST, GROVE, OK 74344-2907
(918) 787-8980
(918) 787-6052
Mailing address
PO BOX 453144, GROVE, OK 74345-3144
(918) 787-8980
(918) 787-6052
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Enumeration date
10/05/2009
Last updated
01/11/2010
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