Provider Demographics
NPI:1932177383
Name:GOODEN, GREGORY P (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:P
Last Name:GOODEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2021 N LEMANS BLVD
Mailing Address - Street 2:APT. # 4403
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1122
Mailing Address - Country:US
Mailing Address - Phone:863-660-1612
Mailing Address - Fax:888-261-6141
Practice Address - Street 1:2021 N LEMANS BLVD
Practice Address - Street 2:APT. # 4403
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1122
Practice Address - Country:US
Practice Address - Phone:863-660-1612
Practice Address - Fax:888-261-6141
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2012-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME51214207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1465681OtherCIGNA
FL259137OtherAVMED
FL5016004OtherAETNA
FLP00409249OtherRAILROAD MEDICARE
FL04253OtherBLUE CROSS BLUE SHIELD
FLP00409249OtherRAILROAD MEDICARE
FLD50968Medicare UPIN