| Doctor Name: | CLYDE LEROY GOODMAN |
| NPI Number: | 1801823083 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | D7984 |
| Business Practice Address: | 4840 Bryant Irvin Ct. Suite 104 Fort Worth, TX - 761077680 |
| Business Phone Number: | 8173354549 |
| Business Fax Number: | 8173770970 |
| Mailing Address: | 4840 Bryant Irvin Ct., Suite 104 FORT WORTH |
| State: | TX |
| Postal Code: | 761077680 |
| Phone Number: | 8173354549 |
| Fax Number: | 8173770970 |
| NPI Enumeration Date: | 06/26/2006 |
| NPI Last Update Date: | 10/04/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | D7984 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |