Individual
DR. WALLACE HANNA GOOD JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
042-0006834
VT
207L00000X
Anesthesiology Physician
144954
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006375
—
VT
05
—
01053034
—
NY
01
—
06375
BLUE SHIELD
VT
01
—
86095
MVP
VT
Enumeration date
07/10/2006
Last updated
07/08/2007
Update your record
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