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NPI Code Detail

MEDICARE: MARK D. GOODMAN M.D.

MEDICARE: MARK D. GOODMAN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician17235NE

General Provider Information

NPI Number : 1326157124
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK D. GOODMAN M.D.
Provider Business Mailing Address
First Line : 7261 MERCY RD
Second Line :
City : OMAHA
State : NE
Zip : 68124-2311
Country : US
Telephone Number : 402-398-6254
Fax Number : 402-829-8513
Provider Business Practice Location Address
First Line : 1319 LEAVENWORTH ST
Second Line :
City : OMAHA
State : NE
Zip : 68102-3215
Country : US
Telephone Number : 402-717-0420
Fax Number : 402-717-6042
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2006
Last Update Date : 11/09/2016

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