Organization
ANESTHESIA ASSOCIATES OF GRAND LAKE
Active
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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