Provider Demographics
NPI:1336310028
Name:GOODELL, BRIAN WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:WAYNE
Last Name:GOODELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24705 142ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-5152
Mailing Address - Country:US
Mailing Address - Phone:253-631-6154
Mailing Address - Fax:
Practice Address - Street 1:24705 142ND AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-5152
Practice Address - Country:US
Practice Address - Phone:253-631-6154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00011813207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology