Provider Demographics
NPI:1356669865
Name:GOETZ, LINDSEY RAE (MD)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:RAE
Last Name:GOETZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4150 V STREET
Mailing Address - Street 2:PSSB 3500
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1460
Mailing Address - Country:US
Mailing Address - Phone:916-734-3014
Mailing Address - Fax:916-734-7920
Practice Address - Street 1:4150 V STREET
Practice Address - Street 2:PSSB 3500
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-3014
Practice Address - Fax:916-734-7920
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA079260207RN0300X
MTMED-PHYS-LIC-60599207RN0300X
CODR0052324207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09000267Medicaid
CO506543YVYPOtherMEDICARE PTAN