Healthcare Provider Details

I. General information

NPI: 1285138768
Provider Name (Legal Business Name): BRIAN GOODMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9970 CENTRAL PARK BLVD. SUITE 302
BOCA RATON FL
33428-2237
US

IV. Provider business mailing address

7800 SW 87TH AVE STE C-340
MIAMI FL
33173-3570
US

V. Phone/Fax

Practice location:
  • Phone: 561-883-6400
  • Fax: 305-279-5899
Mailing address:
  • Phone: 305-595-0109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME0161212
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberME161212
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: