Individual
RAYMOND C. GOODMAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7001 ROGERS AVE, SUITE 200, FORT SMITH, AR 72903-4073
(479) 314-4620
(479) 314-4629
Mailing address
5401 ELLSWORTH RD, FORT SMITH, AR 72903-3219
(479) 314-4757
(479) 314-4704
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
C4716
AR
208600000X
Surgery Physician
Primary
C-4716
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100082220A
OK MEDICAID
AR
05
—
105795001
—
AR
01
—
51933
AR BLUECROSS BLUESHIELD
AR
Enumeration date
05/18/2006
Last updated
12/21/2011
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