Healthcare Provider Details

I. General information

NPI: 1275670671
Provider Name (Legal Business Name): KARYN A GOODMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 AURORA CT SUITE 1032
AURORA CO
80045-2517
US

IV. Provider business mailing address

4600 S COLUMBINE CT
CHERRY HILLS VILLAGE CO
80113-7107
US

V. Phone/Fax

Practice location:
  • Phone: 720-848-0909
  • Fax:
Mailing address:
  • Phone: 917-334-4719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number219411-1
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: