MEDICARE: MRS. DORCAS B GOODMAN ARNP

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	207R00000X	Internal Medicine Physician	ARNP678852	FL
2	363LF0000X	Family Nurse Practitioner	APRN678852	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	:	1467520114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DORCAS B GOODMAN ARNP

Provider Business Mailing Address
First Line	:	403 E 11TH ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-3409
Country	:	US
Telephone Number	:	850-643-1155
Fax Number	:	850-643-1163

Provider Business Practice Location Address
First Line	:	11033 NW STATE ROAD 20
Second Line	:
City	:	BRISTOL
State	:	FL
Zip	:	32321-6406
Country	:	US
Telephone Number	:	850-643-1155
Fax Number	:

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	03/19/2024

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