| Doctor Name: | CHAD BRIAN GOODERHAM |
| NPI Number: | 1639153091 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | FNP |
| License Number: | 1927-033 |
| Business Practice Address: | 1060 Gaffney Rd Fort Wainwright, AK - 997035001 |
| Business Phone Number: | 9073535286 |
| Business Fax Number: | |
| Mailing Address: | 1123 Shannon Dr, FAIRBANKS |
| State: | AK |
| Postal Code: | 997013811 |
| Phone Number: | 9074575158 |
| Fax Number: | |
| NPI Enumeration Date: | 11/30/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 1927-033 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | WI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |