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Individual
TIMOTHY JAMES GOODRIDGE
Active
Individual
TIMOTHY JAMES GOODRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
A.A.
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
343
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430055881
RAILROAD MEDICARE
TX
Enumeration date
01/30/2007
Last updated
12/16/2021
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