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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 14 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1801823083 NPPES
Texas MEDICAID 034680101

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