Individual
GREGORY G GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
5325 FARAON ST, SAINT JOSEPH, MO 64506-3488
(816) 271-7986
(816) 271-7986
Mailing address
5325 FARAON ST, SAINT JOSEPH, MO 64506-3488
(816) 271-7986
(816) 271-7986
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
095469
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10001503301
COMMUNITY HEALTH PLAN
MO
05
—
200553990A
—
KS
05
—
200553990B
—
KS
05
—
200553990C
—
KS
05
—
200553990D
—
KS
01
—
30405021
BCBS
—
05
—
425076601
—
MO
05
—
540492501
—
MO
Enumeration date
08/29/2006
Last updated
10/13/2016
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