Provider Demographics
NPI:1538109988
Name:GOOLSBY, HENRY J III (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:J
Last Name:GOOLSBY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:501 DR MICHAEL DEBAKEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5724
Mailing Address - Country:US
Mailing Address - Phone:337-312-8360
Mailing Address - Fax:337-312-6711
Practice Address - Street 1:2002 W WALNUT ST STE 2
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5690
Practice Address - Country:US
Practice Address - Phone:337-312-8234
Practice Address - Fax:337-312-8411
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA201907207RH0003X
TNMD0000024339207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1130664Medicaid
LA1130664Medicaid
TN3711383Medicare ID - Type Unspecified
4N0307460Medicare PIN