Provider Demographics
NPI:1629727219
Name:GOODGION, DOUGLAS
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:GOODGION
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2088 NE KIM LN
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6588
Mailing Address - Country:US
Mailing Address - Phone:206-321-0014
Mailing Address - Fax:
Practice Address - Street 1:2088 NE KIM LN
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6588
Practice Address - Country:US
Practice Address - Phone:206-321-0014
Practice Address - Fax:206-385-9015
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant