MEDICARE: DR. BRUCE MICHAEL GOODSON 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	38068	NC

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

General Provider Information

NPI Number	:	1366403578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE MICHAEL GOODSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 11223
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28603-6402
Country	:	US
Telephone Number	:	828-322-7700
Fax Number	:	828-256-6720

Provider Business Practice Location Address
First Line	:	1251 16TH ST NE
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28601-4261
Country	:	US
Telephone Number	:	828-322-7700
Fax Number	:	828-256-6720

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	08/16/2011

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