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NPI Code Detail

MEDICARE: JUSTIN GOODEN MD

MEDICARE: JUSTIN GOODEN MD
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
1208D00000XGeneral Practice Physician04-36002KS
22083P0011XUndersea and Hyperbaric Medicine (Preventive Medicine) Physician04-36002KS

General Provider Information

NPI Number : 1205127982
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN GOODEN MD
Provider Business Mailing Address
First Line : 10346 E STONEGATE LN STE 100
Second Line :
City : WICHITA
State : KS
Zip : 67206-2054
Country : US
Telephone Number : 316-871-0995
Fax Number :
Provider Business Practice Location Address
First Line : 10346 E STONEGATE LN STE 100
Second Line :
City : WICHITA
State : KS
Zip : 67206-2054
Country : US
Telephone Number : 316-871-0995
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2011
Last Update Date : 05/21/2025

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Directions to “ JUSTIN GOODEN MD” Practice Location

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