Individual
MR. JOHN JOSEPH GOEDERT III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1200 BARRETT BLVD, HENDERSON, KY 42420-4950
(270) 844-8600
(270) 844-8610
Mailing address
PO BOX 23229, OWENSBORO, KY 42304-3229
(270) 691-8070
(270) 691-8026
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10001845A
IN
363A00000X
Physician Assistant
Primary
TC699
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
KY
Enumeration date
07/07/2015
Last updated
04/23/2018
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