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NPI Code Detail

MEDICARE: DR. JACK ANDREW GOODMAN M.D.

MEDICARE: DR. JACK ANDREW 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
1207L00000XAnesthesiology PhysicianMD0000014100TN

General Provider Information

NPI Number : 1710038161
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACK ANDREW GOODMAN M.D.
Provider Business Mailing Address
First Line : 4515 POPLAR AVE STE 426
Second Line :
City : MEMPHIS
State : TN
Zip : 38117-7517
Country : US
Telephone Number : 901-683-6083
Fax Number : 901-761-2364
Provider Business Practice Location Address
First Line : 4515 POPLAR AVE STE 426
Second Line :
City : MEMPHIS
State : TN
Zip : 38117-7517
Country : US
Telephone Number : 901-683-6083
Fax Number : 901-761-2364
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2007
Last Update Date : 07/08/2007

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Directions to “ DR. JACK ANDREW GOODMAN M.D.” Practice Location

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