Search › Illinois › 367500000X
Wallace Goforth, CRNA
NPI 1497295901 · on the registry since 2017
Practice
- Address
- 405 W Jackson St
Carbondale, IL 62901 - Phone
- (618) 549-0721
- Organisation at this address
- Brigham Anesthesia South Llc
River2 Emergency Physicians Llp
Memorial Hospital Of Carbondale
Southern Illinois Hospital Services
Midwest Regional Neonatology Associates, LlcInferred from a shared address, not stated in the registry. - Clinicians at this address
- 163
Additional practice sites
- 12222 Merit Dr Ste 600, Dallas, TX
Registry record
- Primary taxonomy
- 367500000X
367500000X
- Also registered as
- 367500000X
163W00000X
367500000X - Licence states on file
- TX, IL, NY
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2025-10-09
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois