Provider Demographics
NPI:1942316682
Name:GOOD, DANIEL JOHN (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOHN
Last Name:GOOD
Suffix:
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 1:5419 N LOVINGTON HWY
Mailing Address - Street 2:SUITE 22
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-9100
Mailing Address - Country:US
Mailing Address - Phone:806-470-5400
Mailing Address - Fax:
Practice Address - Street 1:5419 N LOVINGTON HWY
Practice Address - Street 2:LEA REGIONAL MEDICAL CENTER
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240
Practice Address - Country:US
Practice Address - Phone:575-492-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8554207W00000X
CAA064629207W00000X
ARE2486207W00000X
TN42264207W00000X
NMMD2014-0535207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GS47544Medicare UPIN