MEDICARE: DR. CARL WILLIAM GOODCHILD III M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME103314	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023232600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARL WILLIAM GOODCHILD III M.D.

Provider Business Mailing Address
First Line	:	4902 EISENHOWER BLVD.
Second Line	:	SUITE 300
City	:	TAMPA
State	:	FL
Zip	:	33634-6344
Country	:	US
Telephone Number	:	813-636-2000
Fax Number	:	813-792-2561

Provider Business Practice Location Address
First Line	:	12780 RACE TRACK ROAD
Second Line	:	SUITE 400
City	:	TAMPA
State	:	FL
Zip	:	33626-1395
Country	:	US
Telephone Number	:	813-321-6262
Fax Number	:	813-792-2561

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	03/25/2010

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