Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | ME 114669 | FL |
NPI | 1932289154 |
---|---|
Provider Name | Dr. Timothy Alwyn Gooden |
First Address | Navarre, FL 32566-2901 |
Second Address | Navarre, FL 32566-2901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 15/12/2012 |