Individual
BAILEY C GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2605 N LEBANON ST, LEBANON, IN 46052-1476
(765) 485-8000
Mailing address
PO BOX 804, LAFAYETTE, IN 47902-0804
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002490A
IN
Other
Enumeration date
07/27/2018
Last updated
07/27/2018
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