Provider Demographics
NPI:1215914478
Name:GOODE, STEPHEN MACARTHUR (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MACARTHUR
Last Name:GOODE
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 1:200 W MAGNOLIA AVE
Mailing Address - Street 2:100
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7644
Mailing Address - Country:US
Mailing Address - Phone:817-332-4005
Mailing Address - Fax:
Practice Address - Street 1:200 W MAGNOLIA AVE
Practice Address - Street 2:#100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7644
Practice Address - Country:US
Practice Address - Phone:817-332-4005
Practice Address - Fax:817-332-4039
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094881202Medicaid
TX094881202Medicaid
TXB76314Medicare UPIN