Provider Demographics
NPI:1457461501
Name:GOODHEART, THOMAS ARMSTRONG (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ARMSTRONG
Last Name:GOODHEART
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:19582 BEACH BLVD
Mailing Address - Street 2:STE 316
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-5924
Mailing Address - Country:US
Mailing Address - Phone:714-593-0272
Mailing Address - Fax:714-593-6272
Practice Address - Street 1:19582 BEACH BLVD
Practice Address - Street 2:STE 316
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-5924
Practice Address - Country:US
Practice Address - Phone:714-593-0272
Practice Address - Fax:714-593-6272
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2021-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG63540207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33-0607586OtherTAX ID
CAG063540OtherLIC NUMBER