Healthcare Provider Details

I. General information

NPI: 1477790806
Provider Name (Legal Business Name): JOHN M GOAD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 VIRGINIA ST 4TH FLOOR
DUNEDIN FL
34698
US

IV. Provider business mailing address

PO BOX 2216
DUNEDIN FL
34697
US

V. Phone/Fax

Practice location:
  • Phone: 727-734-6932
  • Fax: 727-734-4516
Mailing address:
  • Phone: 727-734-6932
  • Fax: 727-734-4516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0102202609
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberOS10727
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: