Healthcare Provider Details

I. General information

NPI: 1679556633
Provider Name (Legal Business Name): MATTHEW MORTENSEN GOODMAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13830 W CAMINO DEL SOL STE 240
SUN CITY WEST AZ
85375-4746
US

IV. Provider business mailing address

13830 W CAMINO DEL SOL STE 240
SUN CITY WEST AZ
85375-4746
US

V. Phone/Fax

Practice location:
  • Phone: 623-254-7375
  • Fax: 623-259-6754
Mailing address:
  • Phone: 623-254-7375
  • Fax: 623-259-6754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number20487
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number20487
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: