Individual
TONI B GOODYKOONTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1400 JOHNSON AVE, SUITE 4H, BRIDGEPORT, WV 26330-1063
(304) 842-1990
(304) 842-4471
Mailing address
1400 JOHNSON AVE, SUITE 4H, BRIDGEPORT, WV 26330-1063
(304) 842-1990
(304) 842-4471
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
15898
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0115011000
—
WV
Enumeration date
07/07/2005
Last updated
03/29/2013
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