Provider Demographics
NPI:1154301471
Name:GOUDY, JAMES A II (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:GOUDY
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:700 N COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:OH
Mailing Address - Zip Code:44827-1455
Mailing Address - Country:US
Mailing Address - Phone:419-468-0511
Mailing Address - Fax:419-468-8579
Practice Address - Street 1:270 PORTLAND WAY S
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833
Practice Address - Country:US
Practice Address - Phone:419-468-8323
Practice Address - Fax:419-462-5567
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057542G207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0747124Medicaid
OH000000371100OtherANTHEM BCBS
E70873Medicare UPIN
OH7179511Medicare ID - Type Unspecified