Provider Demographics
NPI:1366768699
Name:GOFORTH, WILLIAM DAVID (DPM)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DAVID
Last Name:GOFORTH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8144
Mailing Address - Country:US
Mailing Address - Phone:541-779-5227
Mailing Address - Fax:541-779-1938
Practice Address - Street 1:490 MURPHY RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8144
Practice Address - Country:US
Practice Address - Phone:541-779-5227
Practice Address - Fax:541-779-1938
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORDP163162213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program