Provider Demographics
NPI:1265446991
Name:GOODE, ROY LOUIS (MD)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:LOUIS
Last Name:GOODE
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 1:2345 NORTHPARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203
Mailing Address - Country:US
Mailing Address - Phone:812-372-8293
Mailing Address - Fax:812-378-2042
Practice Address - Street 1:2345 NORTHPARK DRIVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203
Practice Address - Country:US
Practice Address - Phone:812-372-8293
Practice Address - Fax:812-378-2042
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10782215OtherCAQH
IN20000174DMedicaid
IND50338Medicare UPIN
IN228980EMedicare PIN