Provider Demographics
NPI:1871765925
Name:GOODY, NORMAN L (MD)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:L
Last Name:GOODY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75-809 KEAOLANI DR
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-8815
Mailing Address - Country:US
Mailing Address - Phone:808-987-6465
Mailing Address - Fax:877-296-6734
Practice Address - Street 1:75-809 KEAOLANI DR
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740
Practice Address - Country:US
Practice Address - Phone:808-987-6465
Practice Address - Fax:877-296-6734
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-9108207L00000X, 207LA0401X, 207LH0002X, 208VP0000X, 207LP2900X, 207PH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No207LH0002XAllopathic & Osteopathic PhysiciansAnesthesiologyHospice and Palliative Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI20619-3Medicaid
000D0206195OtherHMSA INDIVIDUAL PROVIDER ID
HIF55789OtherUPIN
HIF55789OtherUPIN
HIJ14282Medicare UPIN