Provider Demographics
NPI:1083963888
Name:GOODE, ROBERT EDWIN II (MLT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EDWIN
Last Name:GOODE
Suffix:II
Gender:M
Credentials:MLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5315 DANA DR
Mailing Address - Street 2:APARTMENT G
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-2369
Mailing Address - Country:US
Mailing Address - Phone:919-896-8585
Mailing Address - Fax:
Practice Address - Street 1:5315 DANA DR
Practice Address - Street 2:APARTMENT G
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-2369
Practice Address - Country:US
Practice Address - Phone:919-896-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC79516246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory