Provider Demographics
NPI:1770786618
Name:GOOD, DAVID EMERSON (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:EMERSON
Last Name:GOOD
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 1:916 N WHITE SANDS BLVD
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6926
Mailing Address - Country:US
Mailing Address - Phone:575-434-0180
Mailing Address - Fax:575-434-0181
Practice Address - Street 1:916 N WHITE SANDS BLVD
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6926
Practice Address - Country:US
Practice Address - Phone:575-434-0180
Practice Address - Fax:575-434-0181
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023364207R00000X
ALMD28456207RC0000X
NMMD2014-0139207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM78852366Medicaid
NM348261YKR1OtherMEDICARE PTAN
AL51009742OtherBCBS PROVIDER
AL51007213OtherBCBS PROVIDER #
AL510060011OtherMEDICARE PROVIDER