Healthcare Provider Details

I. General information

NPI: 1336761246
Provider Name (Legal Business Name): NORMAN GOODY, MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-809 KEAOLANI DR
KAILUA KONA HI
96740-8815
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 Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NORMAN L GOODY
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 808-987-6465