Individual
DR. SALLY H. GOUDREAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5323 HARRY HINES BLVD, DALLAS, TX 75390-7201
(214) 645-2554
Mailing address
PO BOX 845347, DALLAS, TX 75284-5347
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
H6037
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102967002
—
TX
05
—
102967003
—
TX
Enumeration date
07/18/2005
Last updated
04/11/2017
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