Provider Demographics
NPI:1467520114
Name:GOODMAN, DORCAS B (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:DORCAS
Middle Name:B
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:DORCAS
Other - Middle Name:
Other - Last Name:BONTRAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:403 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3409
Mailing Address - Country:US
Mailing Address - Phone:850-643-1155
Mailing Address - Fax:850-643-1163
Practice Address - Street 1:11033 NW STATE ROAD 20
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321-6406
Practice Address - Country:US
Practice Address - Phone:850-643-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP678852207R00000X
FLAPRN678852363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300957200Medicaid
S98636Medicare UPIN
FL300957200Medicaid