Wallace Adam Goforth

  • NPI 1497295901
According to our database, the NPI number for Wallace Adam Goforth is 1497295901 and activated since 7 years ago. Wallace Adam Goforth is an individual provider who specializes in Nurse Anesthetist, Certified Registered, and the primary practice location is 405 W Jackson St, Carbondale, IL 62901. You can also contact Wallace Adam Goforth via telephone number is (618) 549-0721. Provider NPI information was last updated on 06/27/2019.

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Overview of Wallace Adam Goforth

  • NPI number: 1598434045
  • Provider type: Individual
  • Gender: Male
  • Active since: 03/02/2017
  • Last updated: 06/27/2019

Primary Scrop of Practice

  • Taxonomy Code: 367500000X
  • Specialty: Nurse Anesthetist, Certified Registered
  • License Number: 209016165
  • License State: IL

Provider Mailing Address

  • Address: 35 Albany Rd Ste C
    Carbondale, IL 62903
  • Phone: 618-457-5111
  • Fax:

Provider Practice Location

  • Address: 405 W Jackson St
    Carbondale, IL 62901
  • Phone: 618-549-0721
  • Fax:

Scope of Practice

  • Taxonomy Code: 163W00000X
  • Specialty: Registered Nurse
  • License Number: 041.449328
  • License State: IL
  • Switch: No

Question & Answers

  • Q: What is the npi number?
  • A: An NPI is a 10-digit numeric identifier. It does not carry information about you, such as the State where you practice, your provider type, or your specialization. Your NPI will not change, even if your name, address, taxonomy, or other information changes.
  • Q: What are health care provider taxonomy codes?
  • A: The Health Care Provider (HCP) Taxonomy Codes Codes define a health care service provider type, classification, and area of specialization.
  • Q: What is the npi number for Wallace Adam Goforth?
  • A: The npi number for Wallace Adam Goforth is 1497295901.
  • Q: What are Wallace Adam Goforth's specialties?
  • A: Wallace Adam Goforth's specialties are Nurse Anesthetist, Certified Registered and different specialities.
  • Q: What is the medical license for Wallace Adam Goforth?
  • A: The medical license number for Wallace Adam Goforth is 209016165 and issued in IL in USA.
  • Q: Where is Wallace Adam Goforth practice location?
  • A: Wallace Adam Goforth is practicing at 405 W Jackson St, Carbondale, IL 62901.
  • Q: How to contact Wallace Adam Goforth?
  • A: You can contact Wallace Adam Goforth via 618-549-0721.
Medicare Specialty
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