Organization
BOARD CERTIFIED PLASTIC SURGEON, P.A.
Active
Other names
RAYMOND C. GOODMAN JR, M.D.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAYMOND C GOODMAN JR. M.D. (OWNER)
(479) 452-9080
Entity
Organization
Contact information
Practice address
2717 S 74TH ST, FORT SMITH, AR 72903-5100
(479) 452-9080
(479) 452-7014
Mailing address
2717 S 74TH ST, FORT SMITH, AR 72903-5100
(479) 452-9080
(479) 452-7014
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
C4716
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105795001
—
AR
Enumeration date
03/15/2007
Last updated
12/31/2008
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