Provider Demographics
NPI:1992865380
Name:GOODING, MATTHEW KIRK (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:KIRK
Last Name:GOODING
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 1:246 CATALINA DR SUITE 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 SUITE 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
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD08203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR069468Medicaid
ORC92738Medicare UPIN
ORR112816Medicare ID - Type Unspecified