Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | NC |
NPI | 1013925023 |
---|---|
Provider Name | Pandora Goode |
First Address | Greensboro, NC 27405-4043 |
Second Address | Greensboro, NC 27405-4043 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F913091C | (05) | NC |
H18113 | (02) |