Provider Demographics
NPI:1083838874
Name:GOODALL, JANIE E (DO, PSYD)
Entity Type:Individual
Prefix:DR
First Name:JANIE
Middle Name:E
Last Name:GOODALL
Suffix:
Gender:F
Credentials:DO, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10401 W THUNDERBIRD BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3004
Mailing Address - Country:US
Mailing Address - Phone:238-324-7286
Mailing Address - Fax:
Practice Address - Street 1:26224 N TATUM BLVD STE 5
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-7500
Practice Address - Country:US
Practice Address - Phone:480-882-7580
Practice Address - Fax:480-563-7442
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ007770207R00000X, 208M00000X
AZR2808207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ148040Medicare PIN
AZZ120233Medicare PIN