Provider Demographics
NPI:1255354593
Name:GOODE, SUSAN PAMELA (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:PAMELA
Last Name:GOODE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11509 E RAFAEL AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-4196
Mailing Address - Country:US
Mailing Address - Phone:347-327-3874
Mailing Address - Fax:
Practice Address - Street 1:535 N WILMOT RD STE 101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2683
Practice Address - Country:US
Practice Address - Phone:520-694-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ622722080P0206X, 2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ088885Medicaid
MA110077405AMedicaid
OK201060510AMedicaid