Provider Demographics
NPI:1679776074
Name:GOFFNEY, WILLIE HENRY JR (MD)
Entity type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:HENRY
Last Name:GOFFNEY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3300 E. SOUTH ST. SUITE 201
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805
Mailing Address - Country:US
Mailing Address - Phone:562-531-9272
Mailing Address - Fax:562-408-0346
Practice Address - Street 1:3300 E. SOUTH ST. SUITE 201
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805
Practice Address - Country:US
Practice Address - Phone:562-531-9272
Practice Address - Fax:562-408-0346
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2015-08-10
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Provider Licenses
StateLicense IDTaxonomies
CAG525902086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A52300Medicare UPIN