Provider Demographics
NPI:1003313271
Name:GOODNER, JOHN DOUGLAS (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DOUGLAS
Last Name:GOODNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4780 CITRUS WAY
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-8811
Mailing Address - Country:US
Mailing Address - Phone:954-288-5814
Mailing Address - Fax:
Practice Address - Street 1:9970 CENTRAL PARK BLVD N STE 300
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-2237
Practice Address - Country:US
Practice Address - Phone:561-488-2200
Practice Address - Fax:561-488-1064
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3986213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery