Provider Demographics
NPI:1467668749
Name:GOODPASTURE, AUDREY BARON (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:BARON
Last Name:GOODPASTURE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12783 JEBB ISLAND CIR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-7921
Mailing Address - Country:US
Mailing Address - Phone:904-223-1278
Mailing Address - Fax:
Practice Address - Street 1:12783 JEBB ISLAND CIR S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-7921
Practice Address - Country:US
Practice Address - Phone:904-223-1278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71553207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine