Provider Demographics
NPI:1184632424
Name:GOODISON, KEISHA A (DO)
Entity Type:Individual
Prefix:DR
First Name:KEISHA
Middle Name:A
Last Name:GOODISON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E SAMPLE ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-3554
Mailing Address - Country:US
Mailing Address - Phone:954-366-3425
Mailing Address - Fax:
Practice Address - Street 1:100 E SAMPLE ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3554
Practice Address - Country:US
Practice Address - Phone:954-366-3425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9480207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine