Basic Information
| Provider Information | |||||||||
| NPI: | 1457551277 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GOOD | ||||||||
| FirstName: | MEADOW | ||||||||
| MiddleName: | MAZE | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 653-1 W 8TH ST | ||||||||
| Address2: | UNIVERSITY OF FLORIDA HEALTH JAX, DEPT OB-GYN | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322096511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042443112 | ||||||||
| FaxNumber: | 9042443658 | ||||||||
| Practice Location | |||||||||
| Address1: | 653-1 W 8TH ST | ||||||||
| Address2: | UF HEALTH JAX, DEPT OB-GYN | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322096511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042443112 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2007 | ||||||||
| LastUpdateDate: | 07/31/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | N1653 | TX | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VG0400X | OS12453 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
No ID Information.