Provider Demographics
NPI:1538166970
Name:GOODYEAR, NATHAN W (MD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:W
Last Name:GOODYEAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 N SCOTTSDALE RD STE 115
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6168
Mailing Address - Country:US
Mailing Address - Phone:865-368-4557
Mailing Address - Fax:888-673-1621
Practice Address - Street 1:11000 N SCOTTSDALE RD STE 115
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6168
Practice Address - Country:US
Practice Address - Phone:865-368-4557
Practice Address - Fax:888-673-1621
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000044259207VG0400X
AZ56029207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI10823Medicare UPIN