Healthcare Provider Details

I. General information

NPI: 1487626552
Provider Name (Legal Business Name): FLOYD KEITH GOODMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHOCTAW WAY
TALIHINA OK
74571-2022
US

IV. Provider business mailing address

RR 2 BOX 2694
TALIHINA OK
74571-9535
US

V. Phone/Fax

Practice location:
  • Phone: 918-567-7000
  • Fax:
Mailing address:
  • Phone: 918-567-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number23887
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: