Healthcare Provider Details

I. General information

NPI: 1184780355
Provider Name (Legal Business Name): MOMDOC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 W FRYE RD STE 9
CHANDLER AZ
85224-6277
US

IV. Provider business mailing address

PO BOX 6730
CHANDLER AZ
85246-6730
US

V. Phone/Fax

Practice location:
  • Phone: 480-821-3600
  • Fax:
Mailing address:
  • Phone: 480-821-3600
  • Fax: 480-857-2667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateAZ
# 8
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateAZ

VIII. Authorized Official

Name: EARL GOODMAN
Title or Position: CEO
Credential:
Phone: 480-821-3600