Provider Demographics
NPI:1679725105
Name:GOODEN, DAVID JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOSEPH
Last Name:GOODEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ONE CHILDREN'S PLAZA
Mailing Address - Street 2:CHILDREN'S ANESTHESIA GROUP, INC.
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-1815
Mailing Address - Country:US
Mailing Address - Phone:937-641-3350
Mailing Address - Fax:937-641-6145
Practice Address - Street 1:ONE CHILDREN'S PLAZA
Practice Address - Street 2:CHILDREN'S ANESTHESIA GROUP, INC.
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-1815
Practice Address - Country:US
Practice Address - Phone:937-641-3350
Practice Address - Fax:937-641-6145
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34.010937207L00000X, 207LP3000X
OH58.002740207L00000X
MO2017017632207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0086212Medicaid
OHH21170Medicare UPIN