Provider Demographics
NPI:1316036783
Name:GOODGAME, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:GOODGAME
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 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:4.112 JOHN SEALY ANNEX
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0570
Mailing Address - Country:US
Mailing Address - Phone:409-772-2653
Mailing Address - Fax:409-772-5462
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:4.112 JOHN SEALY HOSPITAL
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0570
Practice Address - Country:US
Practice Address - Phone:409-772-2653
Practice Address - Fax:409-772-5462
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5215207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F10037Medicare UPIN
TX81J306Medicare PIN
TX110184389Medicare PIN