Provider Demographics
NPI:1609862952
Name:FOGLEMAN, SHARON KAY GOODWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:KAY GOODWIN
Last Name:FOGLEMAN
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:53 QUEENDALE CTR
Mailing Address - Street 2:RED BIRD CLINIC
Mailing Address - City:BEVERLY
Mailing Address - State:KY
Mailing Address - Zip Code:40913-9608
Mailing Address - Country:US
Mailing Address - Phone:606-598-5135
Mailing Address - Fax:606-598-8942
Practice Address - Street 1:53 QUEENDALE CTR
Practice Address - Street 2:RED BIRD CLINIC
Practice Address - City:BEVERLY
Practice Address - State:KY
Practice Address - Zip Code:40913-9608
Practice Address - Country:US
Practice Address - Phone:606-598-5135
Practice Address - Fax:606-598-8942
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY33565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64056377Medicaid
KY0206128Medicare PIN
KY64056377Medicaid