Provider Demographics
NPI:1356225346
Name:GOETTSCH, MADELINE MAE (PA-C)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:MAE
Last Name:GOETTSCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5610
Mailing Address - Country:US
Mailing Address - Phone:214-868-8947
Mailing Address - Fax:
Practice Address - Street 1:1106 SURREY LN
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5610
Practice Address - Country:US
Practice Address - Phone:214-868-8947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-02
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA19335363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant