Provider Demographics
NPI:1720399819
Name:GOODYEAR, ADAM MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:MATTHEW
Last Name:GOODYEAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6265 ROCK CHALK DR
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049
Mailing Address - Country:US
Mailing Address - Phone:785-843-9125
Mailing Address - Fax:785-843-3176
Practice Address - Street 1:6265 ROCK CHALK DR
Practice Address - Street 2:SUITE 1500
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049
Practice Address - Country:US
Practice Address - Phone:785-843-9125
Practice Address - Fax:785-843-3176
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS94-07445207X00000X
KS04-38692207XS0114X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery