Individual
CLYDE LEROY GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4840 BRYANT IRVIN CT., SUITE 104, FORT WORTH, TX 76107-7680
(817) 335-4549
(817) 377-0970
Mailing address
4840 BRYANT IRVIN CT., SUITE 104, FORT WORTH, TX 76107-7680
(817) 335-4549
(817) 377-0970
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
D7984
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
034680101
—
TX
Enumeration date
06/26/2006
Last updated
10/04/2012
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