Healthcare Provider Details

I. General information

NPI: 1215914478
Provider Name (Legal Business Name): STEPHEN MACARTHUR GOODE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W MAGNOLIA AVE #100
FORT WORTH TX
76104-7644
US

IV. Provider business mailing address

200 W MAGNOLIA AVE 100
FORT WORTH TX
76104-7644
US

V. Phone/Fax

Practice location:
  • Phone: 817-332-4005
  • Fax: 817-332-4039
Mailing address:
  • Phone: 817-332-4005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberG3400
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG3400
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: