Basic Information
| Provider Information | |||||||||
| NPI: | 1750470662 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOODHART | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4780 N JOSEY LN | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750104615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724921334 | ||||||||
| FaxNumber: | 9724925174 | ||||||||
| Practice Location | |||||||||
| Address1: | 4780 N JOSEY LN | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750104615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724921334 | ||||||||
| FaxNumber: | 9724925174 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 02/01/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | H7743 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | H7743 | TX | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00913364 | 01 | TX | RAILROAD MEDICARE | OTHER | 8CR158 | 01 | TX | BCBS TX 02/01/2011 | OTHER | 6484850003 | 01 | TX | MEDICARE NSC - EFFECT. 02/01/2011 | OTHER | TXB117559 | 01 | TX | MEDICARE PART B - EFFECT. 02/01/2011 | OTHER | 113597205 | 05 | TX | MEDICAID | 8F4980 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |