Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 0101246282 | VA |
NPI | 1053574780 |
---|---|
Provider Name | Dr. Ronald Goodlett |
First Address | West Point, NY 10996 |
Second Address | Fort Hood, TX 76544-5060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 29/01/2019 |