MEDICARE: JORY F. GOODMAN MD PC

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	2084P0800X	Psychiatry Physician	G34802	CA

General Provider Information

NPI Number	:	1487890950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JORY F. GOODMAN MD PC

Provider Business Mailing Address
First Line	:	9730 WILSHIRE BLVD.
Second Line	:	SUITE 216A
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-2030
Country	:	US
Telephone Number	:	310-858-1700
Fax Number	:	310-887-4708

Provider Business Practice Location Address
First Line	:	9730 WILSHIRE BLVD.
Second Line	:	SUITE 216A
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-2030
Country	:	US
Telephone Number	:	310-858-1700
Fax Number	:	310-887-4708

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JORY FREDERIC GOODMAN
Credential	:	MD
Telephone Number	:	310-858-1700

Provider Enumeration Date	:	01/05/2009
Last Update Date	:	01/05/2009

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