Provider Demographics
NPI:1659491660
Name:GOODYEAR, DANIEL MILLETT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MILLETT
Last Name:GOODYEAR
Suffix:JR
Gender:M
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:P.O. BOX 1015
Mailing Address - Street 2:30 WEST MAIN STREET, RICHMOND FAMILY MEDICINE
Mailing Address - City:RICHMOND
Mailing Address - State:VT
Mailing Address - Zip Code:05477
Mailing Address - Country:US
Mailing Address - Phone:802-434-4123
Mailing Address - Fax:
Practice Address - Street 1:30 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VT
Practice Address - Zip Code:05477
Practice Address - Country:US
Practice Address - Phone:802-434-4123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420011533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine