Healthcare Provider Details

I. General information

NPI: 1356305783
Provider Name (Legal Business Name): NEIL F GOODMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9150 SW 87TH AVE SUITE 210
MIAMI FL
33176-2319
US

IV. Provider business mailing address

9150 SW 87TH AVE SUITE 210
MIAMI FL
33176-2319
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-6855
  • Fax: 305-595-4846
Mailing address:
  • Phone: 305-595-6855
  • Fax: 305-595-4846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME0021486
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: