Clyde Leroy Goodman, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

D7984 Issued in TX

Practice address

4840 Bryant Irvin CT.
Suite 104
Fort Worth, TX 76107-7680

Phone

(817) 335-4549

Fax

(817) 377-0970

NPI assigned

Jun 26, 2006

Last updated

Oct 4, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• C. Leroy Goodman Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• West Fort Worth Dermatology, P.a.

  • Dermatology Physician
  • Fort Worth, TX
  • NPI 1447702964
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349308800000",
    "number": "1801823083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4840 BRYANT IRVIN CT.",
            "address_2": "SUITE 104",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761077680",
            "telephone_number": "817-335-4549",
            "fax_number": "817-377-0970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4840 BRYANT IRVIN CT.",
            "address_2": "SUITE 104",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761077680",
            "telephone_number": "817-335-4549",
            "fax_number": "817-377-0970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODMAN",
        "first_name": "CLYDE",
        "middle_name": "LEROY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2012-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "TX",
            "license": "D7984",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "034680101",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "C.",
            "last_name": "GOODMAN",
            "middle_name": "LEROY",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Daniel Morgan Good, MD
• Mallory Lynn Goodall
• Stephen Macarthur Goode, M.D.
• Yazmine Gigi Goode
• Tori Gooden, DO
• Ellen I Goodman, LVN
• Tina H Goodman, RPH
• Zachary Joseph Powell Goodman, MD
• Melanie Carole Goodrich, LOT
• Toyya S Goodrich, DO

• General Practice Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• General Practice Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.