Healthcare Provider Details

I. General information

NPI: 1306828157
Provider Name (Legal Business Name): JAMES EDGAR GOODNIGHT JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD DEPARTMENT OF SURGERY
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

2315 STOCKTON BLVD DEPARTMENT OF SURGERY
SACRAMENTO CA
95817-2201
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3190
  • Fax: 916-734-5119
Mailing address:
  • Phone: 916-734-3190
  • Fax: 916-734-5119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberC370620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: