Provider Demographics
NPI:1720144827
Name:GOODELL, RONALD JEFFREY (DO)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JEFFREY
Last Name:GOODELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1201 S DOUGLAS BLVD
Mailing Address - Street 2:SUITE L
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-5239
Mailing Address - Country:US
Mailing Address - Phone:405-736-9300
Mailing Address - Fax:
Practice Address - Street 1:1201 S DOUGLAS BLVD
Practice Address - Street 2:SUITE L
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5239
Practice Address - Country:US
Practice Address - Phone:314-239-3527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4473207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology