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Contact Information

CHARLES M GOEDECKE, LSA
16100 SH 288
PEARLAND, TX77584
 Phone: 210-445-9456
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgical

363AS0400X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for CHARLES M GOEDECKE · (Male)

NPI # 1306396759
Status Active
Credentials LSA
Entity Individual
Enumeration date 10/10/2016
Last updated 10/08/2021 - About 5 years ago
Sole proprietor 1 Yes
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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