Basic Information
| Provider Information | |||||||||
| NPI: | 1699137604 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOODSELL | ||||||||
| FirstName: | ALEXANDER | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY OF KENTUCKY | ||||||||
| Address2: | 800 ROSE STREET | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593236762 | ||||||||
| FaxNumber: | 8593231315 | ||||||||
| Practice Location | |||||||||
| Address1: | UNIVERSITY OF KENTUCKY | ||||||||
| Address2: | 800 ROSE STREET | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593232636 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2016 | ||||||||
| LastUpdateDate: | 07/04/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | R4074 | KY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.