MEDICARE: ROY ALLEN GOODART 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	207W00000X	Ophthalmology Physician	1595111205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	107005361101	OTHER	UT	IHC
2	22686096009	OTHER	UT	CIGNA PPO
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	2686096009	OTHER	UT	CIGNA OPEN ACCESS PLUS
5	3264	OTHER	UT	PEHP

General Provider Information

NPI Number	:	1871596411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROY ALLEN GOODART M.D.

Provider Business Mailing Address
First Line	:	4400 S 700 E
Second Line	:	STE 200
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-3000
Country	:	US
Telephone Number	:	801-264-4444
Fax Number	:	801-281-2383

Provider Business Practice Location Address
First Line	:	4400 S 700 E
Second Line	:	STE 200
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-3000
Country	:	US
Telephone Number	:	801-264-4444
Fax Number	:	801-281-2383

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/08/2007

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Directions to “ ROY ALLEN GOODART M.D.” Practice Location

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