Provider Demographics
NPI:1982671434
Name:GOODENOUGH, ROGER R (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:R
Last Name:GOODENOUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 N COUNTY ROAD 25A
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1337
Mailing Address - Country:US
Mailing Address - Phone:937-440-7497
Mailing Address - Fax:937-440-7337
Practice Address - Street 1:998 S DORSET RD
Practice Address - Street 2:SUITE 301
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-4753
Practice Address - Country:US
Practice Address - Phone:937-339-5441
Practice Address - Fax:937-339-6668
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35031589207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0122030Medicaid
OH0373493Medicare ID - Type Unspecified
OH0122030Medicaid