MEDICARE: DR. IRA LEE 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	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	11747	AZ
2	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	G40445	CA

General Provider Information

NPI Number	:	1942321930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRA LEE GOODMAN MD

Provider Business Mailing Address
First Line	:	8390 E VIA DE VENTURA
Second Line	:	SUITE F-110
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-3188
Country	:	US
Telephone Number	:	602-741-3502
Fax Number	:	888-678-3543

Provider Business Practice Location Address
First Line	:	4316 CORTE DE LA FONDA
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2126
Country	:	US
Telephone Number	:	602-741-3502
Fax Number	:	888-678-3543

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	10/07/2015

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