Healthcare Provider Details

I. General information

NPI: 1871765925
Provider Name (Legal Business Name): NORMAN L GOODY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-809 KEAOLANI DR
KAILUA KONA HI
96740
US

IV. Provider business mailing address

75-809 KEAOLANI DR
KAILUA KONA HI
96740-8815
US

V. Phone/Fax

Practice location:
  • Phone: 808-987-6465
  • Fax: 877-296-6734
Mailing address:
  • Phone: 808-987-6465
  • Fax: 877-296-6734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD-9108
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License NumberMD-9108
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code207LH0002X
TaxonomyHospice and Palliative Medicine (Anesthesiology) Physician
License NumberMD-9108
License Number StateHI
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD-9108
License Number StateHI
# 5
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD-9108
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: