Healthcare Provider Details

I. General information

NPI: 1417982521
Provider Name (Legal Business Name): JOHN M GOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 RIO RANCHO DR SE
RIO RANCHO NM
87124-1052
US

IV. Provider business mailing address

PO BOX 27829
ALBUQUERQUE NM
87125-7829
US

V. Phone/Fax

Practice location:
  • Phone: 505-896-8600
  • Fax: 505-896-8612
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number97250
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: