Provider Demographics
NPI:1174611883
Name:GOODE, JAMES (CRNA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:GOODE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:11517 LADY ALISON CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-4627
Mailing Address - Country:US
Mailing Address - Phone:240-607-9061
Mailing Address - Fax:240-607-9061
Practice Address - Street 1:7300 VAN DUSEN RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-9463
Practice Address - Country:US
Practice Address - Phone:443-332-4088
Practice Address - Fax:410-793-0809
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2008-08-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDR1800054367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered