Provider Demographics
NPI:1255477691
Name:GOODE, ROBERT JAMES (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:GOODE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 CALIFORNIA ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-3678
Mailing Address - Country:US
Mailing Address - Phone:812-372-4284
Mailing Address - Fax:812-372-5051
Practice Address - Street 1:2525 CALIFORNIA ST
Practice Address - Street 2:SUITE E
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-3678
Practice Address - Country:US
Practice Address - Phone:812-372-4284
Practice Address - Fax:812-372-5051
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01022751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000089096Medicaid
INC25600Medicare UPIN
IN000000089096Medicaid