MEDICARE: GREGORY P GOODEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	ME51214	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00409249	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1465681	OTHER	FL	CIGNA
2	259137	OTHER	FL	AVMED
3	5016004	OTHER	FL	AETNA
5	04253	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1932177383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY P GOODEN MD

Provider Business Mailing Address
First Line	:	2021 N LEMANS BLVD
Second Line	:	APT. # 4403
City	:	TAMPA
State	:	FL
Zip	:	33607-1122
Country	:	US
Telephone Number	:	863-660-1612
Fax Number	:	888-261-6141

Provider Business Practice Location Address
First Line	:	2021 N LEMANS BLVD
Second Line	:	APT. # 4403
City	:	TAMPA
State	:	FL
Zip	:	33607-1122
Country	:	US
Telephone Number	:	863-660-1612
Fax Number	:	888-261-6141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	12/08/2012

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Directions to “ GREGORY P GOODEN MD” Practice Location

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