Provider Demographics
NPI:1619112307
Name:GOODPASTOR, SARAH E (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:E
Last Name:GOODPASTOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 MAIN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4258
Mailing Address - Country:US
Mailing Address - Phone:970-764-9300
Mailing Address - Fax:970-764-9310
Practice Address - Street 1:3235 MAIN AVE STE 2
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4258
Practice Address - Country:US
Practice Address - Phone:970-764-9300
Practice Address - Fax:970-764-9310
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10029280207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CS620OtherBLUE CROSS BLUE SHIELD OF TX
TX8CS620OtherBLUE CROSS BLUE SHIELD OF TX