Healthcare Provider Details

I. General information

NPI: 1407968670
Provider Name (Legal Business Name): JEFFREY J GOON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S 43RD ST
RENTON WA
98055-5714
US

IV. Provider business mailing address

PO BOX 24584
SEATTLE WA
98124-0584
US

V. Phone/Fax

Practice location:
  • Phone: 425-228-3450
  • Fax:
Mailing address:
  • Phone: 425-656-4255
  • Fax: 425-656-4003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10003631
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: