Basic Information
| Provider Information | |||||||||
| NPI: | 1639332893 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOEL | ||||||||
| FirstName: | SUMINA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 S 40TH ST | ||||||||
| Address2: | |||||||||
| City: | MUSKOGEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744014915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186830753 | ||||||||
| FaxNumber: | 9186835677 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 S 40TH ST | ||||||||
| Address2: | |||||||||
| City: | MUSKOGEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744014915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186830753 | ||||||||
| FaxNumber: | 9186835677 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2008 | ||||||||
| LastUpdateDate: | 11/10/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207UN0901X | 29055 | OK | Y | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology | 208D00000X | 262537 | NY | N | Allopathic & Osteopathic Physicians | General Practice | 207U00000X | 29055 | OK | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | 207U00000X | MD441340 | PA | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | 208D00000X | 29055 | OK | N | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 29055 | 01 | OK | LICENSE | OTHER | 262537 | 01 | NY | NY LICENSE | OTHER |