Provider Demographics
NPI:1780009969
Name:GOOD, DAVID H (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:GOOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1200 W. CHEROKEE ST.
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467
Mailing Address - Country:US
Mailing Address - Phone:918-485-5514
Mailing Address - Fax:918-485-0535
Practice Address - Street 1:1202 W. CHEROKEE ST
Practice Address - Street 2:STE E
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467
Practice Address - Country:US
Practice Address - Phone:918-485-1877
Practice Address - Fax:918-485-0535
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK2864207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200569380AMedicaid