Provider Demographics
NPI:1992706212
Name:GOODINE, GLENDA MARIE (MD)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:MARIE
Last Name:GOODINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GLENDA
Other - Middle Name:MARIE
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3801 VISTA RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-2160
Mailing Address - Country:US
Mailing Address - Phone:832-775-9800
Mailing Address - Fax:832-775-9820
Practice Address - Street 1:11452 SPACE CENTER BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77059
Practice Address - Country:US
Practice Address - Phone:832-775-9800
Practice Address - Fax:832-775-9820
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81Y721OtherBLUE CROSS BLUE SHIELD
TX81Y721OtherBLUE CROSS BLUE SHIELD
TXB87875Medicare UPIN