MEDICARE: DR. ADAM J GOODMAN MD

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
1	207P00000X	Emergency Medicine Physician	A114392	CA

General Provider Information

NPI Number	:	1487882841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADAM J GOODMAN MD

Provider Business Mailing Address
First Line	:	1920 6TH ST
Second Line	:	APT 333
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-1285
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1983 MARENGO ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1370
Country	:	US
Telephone Number	:	323-409-1615
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2009
Last Update Date	:	09/20/2012

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