Provider Demographics
NPI:1336761246
Name:NORMAN GOODY, MD INC
Entity Type:Organization
Organization Name:NORMAN GOODY, MD INC
Other - Org Name:PONO MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOODY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-987-6465
Mailing Address - Street 1:75-809 KEAOLANI DR
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-8815
Mailing Address - Country:US
Mailing Address - Phone:808-987-6465
Mailing Address - Fax:877-296-6734
Practice Address - Street 1:75-809 KEAOLANI DR
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-8815
Practice Address - Country:US
Practice Address - Phone:808-987-6465
Practice Address - Fax:877-296-6734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-13
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder