Individual
JACOB DALE GOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1118 ROBERTS ST, SOUTH BEND, IN 46615-3909
(574) 360-5826
Mailing address
1118 ROBERTS ST, SOUTH BEND, IN 46615-3909
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/17/2024
Last updated
07/17/2024
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