Provider Demographics
NPI:1598756595
Name:GOODEN, MICHAEL ALLEN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALLEN
Last Name:GOODEN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5301 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2874
Mailing Address - Country:US
Mailing Address - Phone:520-324-4780
Mailing Address - Fax:520-324-2051
Practice Address - Street 1:1400 N WILMOT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4498
Practice Address - Country:US
Practice Address - Phone:520-324-4220
Practice Address - Fax:520-324-4221
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV224342085R0204X, 2086S0129X
NM20030588208600000X
ND153112086S0129X
AZ436652086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001881734OtherBCBS
WV3810006149Medicaid
AZ558551Medicaid