Provider Demographics
NPI:1366403578
Name:GOODSON, BRUCE MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MICHAEL
Last Name:GOODSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 11223
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-6402
Mailing Address - Country:US
Mailing Address - Phone:828-322-7700
Mailing Address - Fax:828-256-6720
Practice Address - Street 1:1251 16TH ST NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-4261
Practice Address - Country:US
Practice Address - Phone:828-322-7700
Practice Address - Fax:828-256-6720
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2011-08-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC38068207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8936226Medicaid
NCEO2438Medicare UPIN