Provider Demographics
NPI:1811998529
Name:GOOLSBY, JAMES P (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:GOOLSBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:407 S SCHWARTZ AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5925
Mailing Address - Country:US
Mailing Address - Phone:505-609-6770
Mailing Address - Fax:505-609-6775
Practice Address - Street 1:407 S SCHWARTZ AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5925
Practice Address - Country:US
Practice Address - Phone:505-609-6770
Practice Address - Fax:505-609-6775
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2013-05-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF2691207RC0000X
NMMD2004-0655207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
110043155OtherRAILROAD MEDICARE
048690OtherGREAT WEST
TX1238776-03Medicaid
NM47989351Medicaid
TX722439OtherFIRST HEALTH
78756-A014OtherCHAMPUS/TRICARE
TX881627OtherBC/BS
B23072Medicare UPIN