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General NPI Number Information
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NPI Number | 1083748966
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Entity Type | Individual
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Provider Name | SCOTT T GOODRICH M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 2514 E DUPONT RD STE 100
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City | FORT WAYNE
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State | IN
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Zip | 46825-1619
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Country | US
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Telephone | 260-484-8830
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Fax | 260-483-1911
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Provider Business Mailing Address
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Address Line | PO BOX 749495
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City | ATLANTA
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State | GA
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Zip | 30374-9495
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Country | US
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Telephone | 855-963-2100
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Fax | 239-236-2775
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 01078092A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | 01078092A
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License Number State | IN
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