Provider Demographics
NPI:1023232600
Name:GOODCHILD, CARL WILLIAM III (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:WILLIAM
Last Name:GOODCHILD
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:4902 EISENHOWER BLVD.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6344
Mailing Address - Country:US
Mailing Address - Phone:813-636-2000
Mailing Address - Fax:813-792-2561
Practice Address - Street 1:12780 RACE TRACK ROAD
Practice Address - Street 2:SUITE 400
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1395
Practice Address - Country:US
Practice Address - Phone:813-321-6262
Practice Address - Fax:813-792-2561
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2010-03-25
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Provider Licenses
StateLicense IDTaxonomies
FLME103314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0053988122Medicaid
FL0053988122Medicaid