Provider Demographics
NPI:1598203697
Name:GOODE, WILLIAM T I (PA-C)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:T
Last Name:GOODE
Suffix:I
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 COVENTRY RD
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1136
Mailing Address - Country:US
Mailing Address - Phone:716-803-4007
Mailing Address - Fax:
Practice Address - Street 1:5320 MILITARY RD STE 104
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-2149
Practice Address - Country:US
Practice Address - Phone:716-205-8324
Practice Address - Fax:716-205-8593
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020606363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant