Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 10954 | AL |
NPI | 1154399863 |
---|---|
Provider Name | Michael D Goodlett |
First Address | Auburn, AL 36849 |
Second Address | Auburn, AL 36849 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 18/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
51521101 | BLUE CROSS (01) | AL |
C72284 | (02) |