Provider Demographics
NPI:1235498171
Name:GOODELL, CARA AMY RAPHAEL (MD)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:AMY RAPHAEL
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 1:1023 SPRINGDALE RD STE 1J
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78721-2465
Mailing Address - Country:US
Mailing Address - Phone:512-298-4045
Mailing Address - Fax:
Practice Address - Street 1:1023 SPRINGDALE RD STE 1J
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78721-2465
Practice Address - Country:US
Practice Address - Phone:512-298-4045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-13
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101258160207Q00000X
390200000X
TXQ0642207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program