Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | E6590 | AR |
N | 208D00000X | General Practice Physician | 487 | NE |
NPI | 1003923715 |
---|---|
Provider Name | Mr. Eric P B Goodspeed |
First Address | Fayetteville, AR 72703 |
Second Address | Fayetteville, AR 72703-4424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 31/07/2017 |