# G P GOODFRIED MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639313851
- **Authorized official:** DR. GARY PAUL GOODFRIED MD (ORTHOPEDIC SURGEON/OWNER)
- **Authorized official phone:** (903) 597-5798

## Contact information

- **Practice address:** 1905 S DONNYBROOK AVE, TYLER, TX 75701-4236
- **Practice address phone:** (903) 597-3140
- **Practice address fax:** (903) 595-5693
- **Mailing address:** 1905 S DONNYBROOK AVE, TYLER, TX 75701-4236
- **Mailing address phone:** (903) 597-3140
- **Mailing address fax:** (903) 595-5693

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | F1592 | TX | — |
| 363A00000X | Physician Assistant | PA00823 | TX | Yes |

## Other

- **Enumeration date:** 05/01/2009
- **Last updated:** 12/22/2011