Goodman, Clyde Leroy
Goodman, Clyde Leroy is an individual health care provider with primary practice located at 4840 Bryant Irvin Ct. Suite 104, Fort Worth TX 76107-7680. He recently has only one registered license in Allopathic & Osteopathic Physicians / General Practice, which is considered as his primary health care specialty. Goodman, Clyde Leroy can be contacted via phone (817) 335-4549.Contact Information
Primary practice address
4840 Bryant Irvin Ct. Suite 104
Fort Worth TX 76107-7680
Phone: (817) 335-4549
Fax: (817) 377-0970
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / General Practice | 208D00000X | D7984 | Texas |
Profile Details
| NPI number | 1801823083 |
|---|---|
| LBN Legal business name | Goodman, Clyde Leroy |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 26th, 2006 |
| Last updated | Oct 4th, 2012 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1801823083 | NPPES |
| Texas | MEDICAID | 034680101 |
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