Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 07378 | OH |
Y | 213ES0000X | Sports Medicine | 07378 | OH |
NPI | 1477033736 |
---|---|
Provider Name | Tyler Goode |
First Address | Circleville, OH 43113-9488 |
Second Address | Pickerington, OH 43147-1310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2018 |
Last Update Date | 16/08/2018 |