Healthcare Provider Details

I. General information

NPI: 1881652915
Provider Name (Legal Business Name): ROGER R. GOOD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N KEENE ST SUITE 101
COLUMBIA MO
65201-8131
US

IV. Provider business mailing address

PO BOX 951339
DALLAS TX
75395-1339
US

V. Phone/Fax

Practice location:
  • Phone: 573-499-9995
  • Fax:
Mailing address:
  • Phone: 940-270-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberL0217
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: