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General NPI Number Information
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NPI Number | 1124449442
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Entity Type | Individual
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Provider Name | JOHN ETHAN GOODRICH MD
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Gender | Male
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Dates
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Enumeration Date | 01/06/2014
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Last Update Date | 03/08/2023
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Provider Practice Location Address
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Address Line | 4610 X ST
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City | SACRAMENTO
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State | CA
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Zip | 95817-2200
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Country | US
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Telephone | 916-816-0478
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Fax |
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Provider Business Mailing Address
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Address Line | 2215 ROSE ST
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City | BERKELEY
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State | CA
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Zip | 94709-1430
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Country | US
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Telephone | 424-366-3794
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A149423
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | M-17073
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | A149423
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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