Provider Demographics
NPI:1538318233
Name:GOODRUM, JOSHUA (DO)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:GOODRUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 ASHLAND ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1995
Mailing Address - Country:US
Mailing Address - Phone:541-526-9016
Mailing Address - Fax:541-543-2491
Practice Address - Street 1:2205 ASHLAND ST STE 102
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1995
Practice Address - Country:US
Practice Address - Phone:541-526-9016
Practice Address - Fax:541-543-2491
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015562207Q00000X
ORDO197677204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine