Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | C6030 | AR |
Y | 208600000X | Surgeon | C6030 | AR |
NPI | 1023054467 |
---|---|
Provider Name | Dr. J. David Goodman |
First Address | Clarksville, AR 72830-0440 |
Second Address | Clarksville, AR 72830-4431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
51937 | BCBS OF ARK. (01) | AR |
D04574 | (02) | AR |