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General NPI Number Information
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NPI Number | 1710114558
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Entity Type | Organization
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Legal Business Name | KEISHA GOODISON DO, PA
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Dates
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Enumeration Date | 06/19/2009
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Last Update Date | 09/04/2018
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Provider Practice Location Address
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Address Line | 100 E SAMPLE RD SUITE 300
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City | POMPANO BEACH
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State | FL
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Zip | 33064
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Country | US
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Telephone | 954-366-3425
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Fax | 954-366-3510
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Provider Business Mailing Address
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Address Line | 100 E SAMPLE RD SUITE 300
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City | POMPANO BEACH
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State | FL
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Zip | 33064-3554
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Country | US
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Telephone | 954-366-3425
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Fax | 954-366-3510
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEISHA ADAMA GOODISON
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Credential | DO
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Telephone | 954-366-3425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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