Provider Demographics
NPI:1821156787
Name:MATTHEW KIRK GOODING MD
Entity Type:Organization
Organization Name:MATTHEW KIRK GOODING MD
Other - Org Name:MATTHEW K GOODING, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:KIRK
Authorized Official - Last Name:GOODING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-488-3221
Mailing Address - Street 1:246 CATALINA DR. STE 5
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1624
Mailing Address - Country:US
Mailing Address - Phone:541-488-3221
Mailing Address - Fax:541-488-5884
Practice Address - Street 1:246 CATALINA DR STE 5
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1624
Practice Address - Country:US
Practice Address - Phone:541-488-3221
Practice Address - Fax:541-488-5884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKMD08203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR240532Medicaid
ORR112814Medicare PIN
ORR112814Medicare ID - Type Unspecified