Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 2001001469 | MO |
NPI | 1215075403 |
---|---|
Provider Name | Dr. William W. Goodman III |
First Address | Kansas City, MO 64180-2843 |
Second Address | Monett, MO 65708-8258 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 10/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
205197205 | (05) | MO |
G22539 | (02) | MO |