Individual
WILLIAM D GOUDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1900 CAREW ST STE 6, FORT WAYNE, IN 46805-4765
(260) 266-2500
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02000673A
IN
208D00000X
General Practice Physician
02000673A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000335961
ANTHEM
—
05
—
100103820A
—
IN
01
—
P00144540
MEDICARE RAILROAD
IN
Enumeration date
07/28/2005
Last updated
01/06/2023
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