Provider Demographics
NPI:1184124398
Name:GOODGAME, GINA GREER (RD)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:GREER
Last Name:GOODGAME
Suffix:
Gender:F
Credentials:RD
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Mailing Address - Street 1:414 N SHADOWBEND AVE
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-3839
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2017 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5501
Practice Address - Country:US
Practice Address - Phone:281-485-9990
Practice Address - Fax:281-485-9469
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXDT85180133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT85180OtherTEXAS STATE BOARD OF EXAMINERS OF DIETITIANS
01052685OtherCOMMISSION OF DIETETIC REGISTRATION