Provider Demographics
NPI:1427160035
Name:GOODBRAD, DONALD BURGESS (CRNA)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:BURGESS
Last Name:GOODBRAD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:COLLEGEDALE
Mailing Address - State:TN
Mailing Address - Zip Code:37315-0351
Mailing Address - Country:US
Mailing Address - Phone:406-495-0141
Mailing Address - Fax:
Practice Address - Street 1:5108 SILVER LN
Practice Address - Street 2:
Practice Address - City:APISON
Practice Address - State:TN
Practice Address - Zip Code:37302-9593
Practice Address - Country:US
Practice Address - Phone:406-495-0141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN37535367500000X
TNAPN0000034754367500000X
MTRN29818367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered