Provider Demographics
NPI:1053570929
Name:GOODELL, LAURA M (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:M
Last Name:GOODELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W GLENDALE ST
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-2419
Mailing Address - Country:US
Mailing Address - Phone:406-839-3093
Mailing Address - Fax:
Practice Address - Street 1:41 BARRETT ST
Practice Address - Street 2:DILLON COMMUNITY HEALTH CENTER
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-3508
Practice Address - Country:US
Practice Address - Phone:406-683-4440
Practice Address - Fax:406-683-1121
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine