Healthcare Provider Details

I. General information

NPI: 1922009026
Provider Name (Legal Business Name): DAVID AARON GOODMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W TYLER AVE
WEST MEMPHIS AR
72301-4221
US

IV. Provider business mailing address

108 W TYLER AVE
WEST MEMPHIS AR
72301-4221
US

V. Phone/Fax

Practice location:
  • Phone: 870-732-1191
  • Fax: 870-732-4091
Mailing address:
  • Phone: 870-732-1191
  • Fax: 870-732-4091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-0948
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: