Provider Demographics
NPI:1932513033
Name:GOETZ, IRA ALLENE (ACNS-BC)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:ALLENE
Last Name:GOETZ
Suffix:
Gender:F
Credentials:ACNS-BC
Other - Prefix:
Other - First Name:IRA
Other - Middle Name:ALLENE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNS-BC
Mailing Address - Street 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-7208
Mailing Address - Country:US
Mailing Address - Phone:214-645-8800
Mailing Address - Fax:214-645-8801
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7208
Practice Address - Country:US
Practice Address - Phone:214-645-8800
Practice Address - Fax:214-645-8801
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP124184364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15440OtherRX ID