Healthcare Provider Details

I. General information

NPI: 1437525581
Provider Name (Legal Business Name): GREGORY GOODMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 LINCOLN RD STE 301
MIAMI BEACH FL
33139-2409
US

IV. Provider business mailing address

1111 LINCOLN RD STE 301
MIAMI BEACH FL
33139-2409
US

V. Phone/Fax

Practice location:
  • Phone: 305-703-7633
  • Fax:
Mailing address:
  • Phone: 305-703-7633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME177914
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number274422
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: