Individual
MR. JESSE LEE GOODMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1515 NE LAWRIE TATUM RD, LAWTON, OK 73507-3002
(580) 354-5100
(580) 354-5105
Mailing address
1515 NE LAWRIE TATUM RD, LAWTON, OK 73507-3002
(580) 354-5100
(580) 354-5105
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2244
OK
Other
Enumeration date
12/01/2006
Last updated
04/16/2013
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