Basic Information
| Provider Information | |||||||||
| NPI: | 1962065623 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOODEN | ||||||||
| FirstName: | TONIA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 KINGS HIGHWAY | ||||||||
| Address2: | INTERNAL MEDICINE | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711303932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186260434 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3231 EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | BERWYN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604023471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087833400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2019 | ||||||||
| LastUpdateDate: | 07/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 036160134 | IL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.