MEDICARE: MICHAEL R 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	207Q00000X	Family Medicine Physician	G070755	CA

General Provider Information

NPI Number	:	1528019270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL R GOODMAN MD

Provider Business Mailing Address
First Line	:	173 E WEBSTER ST
Second Line	:
City	:	COLUSA
State	:	CA
Zip	:	95932-2949
Country	:	US
Telephone Number	:	530-458-8050
Fax Number	:	530-458-5936

Provider Business Practice Location Address
First Line	:	173 E WEBSTER ST
Second Line	:
City	:	COLUSA
State	:	CA
Zip	:	95932-2949
Country	:	US
Telephone Number	:	530-458-8050
Fax Number	:	530-458-5936

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	01/25/2014

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