CLYDE LEROY GOODMAN (NPI# 1801823083) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801823083 |
| Entity Type | Individual |
| Full Name | CLYDE LEROY GOODMAN |
| Other Name | C. LEROY GOODMAN |
| Credential | MD |
| Practice Address |
4840 Bryant Irvin Ct. Suite 104 Fort Worth TX 76107-7680 |
| Practice Telephone | 8173354549 |
| Practice Fax Number | 8173770970 |
| Mailing Telephone | 8173354549 |
| Mailing Fax Number | 8173770970 |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2012-10-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | D7984 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 034680101 | 05 |
| Street Address |
4840 BRYANT IRVIN CT. SUITE 104 |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76107-7680 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629683602 | Renovo Wound and Hyperbarics Pllc | Emergency Medicine | 5668 Edwards Ranch Road, Suite 101, Fort Worth, TX 76107 | 2020-09-15 |
| 1669085437 | Ryan Bourgeois | Nurse Practitioner | 2917 Crocket Street, Fort Worth, TX 76107 | 2020-08-31 |
| 1053920546 | Christa Marie Widjaja | Optometrist | 1700 Montgomery St, Fort Worth, TX 76107 | 2020-07-30 |
| 1093351355 | Raymond Iannone | Pharmacist | 850 Montgomery St, Suite #310, Fort Worth, TX 76107 | 2019-11-21 |
| 1053963744 | Cumulus Injury Resolution, Inc. | Chiropractor | 4936 Byers Avenue, Fort Worth, TX 76107 | 2019-07-12 |
| 1770135576 | Shadia Osakwe | Physician Assistant | 855 Montgomery Street, Pediatric Clinic, Fort Worth, TX 76107 | 2019-07-11 |
| 1568945442 | Sachin P Patel | Physical Therapist | 4825 Wellesley St, Fort Worth, TX 76107 | 2018-09-07 |
| 1023594025 | Ftw Pharmacy Services Inc | Durable Medical Equipment & Medical Supplies | 2912 W 6th St Ste 150, Fort Worth, TX 76107 | 2018-07-13 |
| 1669974325 | Helen Williamson Elliott | Counselor | 1751 River Run #217, Fort Worth, TX 76107 | 2018-03-08 |
| 1487156931 | Pelvic Neuromonitoring Pllc | Electrodiagnostic Medicine | 111 Boland St #211, Ft Worth, TX 76107 | 2018-03-01 |
| Find all providers in zip 76107 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174147912 | Earnest A Porter | General Practice | 6324 Glenwick Dr, Fort Worth, TX 76123-1565 | 2020-06-07 |
| 1386200889 | Wholelife Authentic Care Provider Network | General Practice | 1000 Bonnie Brae Ave Ste 120, Fort Worth, TX 76111-4301 | 2019-05-10 |
| 1336681170 | Dynamic Rpa Healthcare Pa | General Practice | 3750 S University Dr Ste 275, Fort Worth, TX 76109-3795 | 2016-11-10 |
| 1588906218 | Susan Moses Shropshire | General Practice | 4812 Camp Bowie Blvd, Suite B, Fort Worth, TX 76107-4121 | 2013-03-20 |
| 1376817932 | Gordon Patterson Sharratt | General Practice | 3605 Roberts Cut Off Rd, Fort Worth, TX 76114-1039 | 2012-02-29 |
| 1063785665 | Linda Atlas Reese | General Practice | 1001 N Rhea Dr, Fort Worth, TX 76108-3565 | 2012-02-14 |
| 1962711036 | Larry Edwin Bradley | General Practice | 7016 Riverport Rd, Fort Worth, TX 76116-9311 | 2010-10-06 |
| 1922210996 | Paul Lyndon Patrick | General Practice | 14805 Trinity Blvd, Fort Worth, TX 76155-2609 | 2007-05-04 |
| 1477607240 | H Pena Md North Main Medical and Surgical Clinic Assoc | General Practice | 3301 North Main Street, Fort Worth, TX 76106 | 2007-01-22 |
| 1518030071 | Barbara Anne Fannin | General Practice | 4101 Marys Creek Dr, Fort Worth, TX 76116 | 2006-11-15 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76107 |
Please comment or provide details below to improve the information on CLYDE LEROY GOODMAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.