Provider Demographics
NPI:1306894894
Name:GOODCHILD, GINGER SUZANNE (DO)
Entity type:Individual
Prefix:DR
First Name:GINGER
Middle Name:SUZANNE
Last Name:GOODCHILD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9410 RAVENSWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-4522
Mailing Address - Country:US
Mailing Address - Phone:817-326-2727
Mailing Address - Fax:817-326-5737
Practice Address - Street 1:2200 JAMES RD
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-8207
Practice Address - Country:US
Practice Address - Phone:817-326-2727
Practice Address - Fax:817-326-5737
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1867207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152036301Medicaid
TX8295B7Medicare PIN
TX152036301Medicaid