Provider Demographics
NPI:1871596411
Name:GOODART, ROY ALLEN (MD)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:ALLEN
Last Name:GOODART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4400 S 700 E
Mailing Address - Street 2:STE 200
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3000
Mailing Address - Country:US
Mailing Address - Phone:801-264-4444
Mailing Address - Fax:801-281-2383
Practice Address - Street 1:4400 S 700 E
Practice Address - Street 2:STE 200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-3000
Practice Address - Country:US
Practice Address - Phone:801-264-4444
Practice Address - Fax:801-281-2383
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT1595111205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107005361101OtherIHC
UT22686096009OtherCIGNA PPO
MT0049543Medicaid
UT2686096009OtherCIGNA OPEN ACCESS PLUS
UT3264OtherPEHP
UT2686096009OtherCIGNA OPEN ACCESS PLUS