Provider Demographics
NPI:1629041769
Name:GOOD, JOHN CHAMBERS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHAMBERS
Last Name:GOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3100 TELEGRAPH AVE
Mailing Address - Street 2:SUITE 2102
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3210
Mailing Address - Country:US
Mailing Address - Phone:810-286-8160
Mailing Address - Fax:510-286-8158
Practice Address - Street 1:3100 TELEGRAPH AVE
Practice Address - Street 2:SUITE 2102
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3210
Practice Address - Country:US
Practice Address - Phone:810-286-8160
Practice Address - Fax:510-286-8158
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG21825207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0028630Medicaid
A41397Medicare UPIN
CAGR0028630Medicaid