# DR. WALLACE HANNA GOOD JR.

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1568496008
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | 042-0006834 | VT | Yes |
| 207L00000X | Anesthesiology Physician | 144954 | NY | — |

## Other

- **Enumeration date:** 07/10/2006
- **Last updated:** 07/08/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0006375 | — | VT |
| 05 | — | 01053034 | — | NY |
| 01 | — | 06375 | BLUE SHIELD | VT |
| 01 | — | 86095 | MVP | VT |