MEDICARE: MICHAEL ALLEN 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
1	2085R0204X	Vascular & Interventional Radiology Physician	22434	WV
2	208600000X	Surgery Physician	20030588	NM
3	2086S0129X	Vascular Surgery Physician	22434	WV
4	2086S0129X	Vascular Surgery Physician	15311	ND
5	2086S0129X	Vascular Surgery Physician	43665	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001881734	OTHER	WV	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598756595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ALLEN GOODEN MD

Provider Business Mailing Address
First Line	:	5301 E GRANT RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-2874
Country	:	US
Telephone Number	:	520-324-4780
Fax Number	:	520-324-2051

Provider Business Practice Location Address
First Line	:	1400 N WILMOT RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-4498
Country	:	US
Telephone Number	:	520-324-4220
Fax Number	:	520-324-4221

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	04/29/2025

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Directions to “ MICHAEL ALLEN GOODEN MD” Practice Location

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