Healthcare Provider Details

I. General information

NPI: 1396770848
Provider Name (Legal Business Name): DAVID SETH GOODMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9125 CORSEA DEL FONTANA WAY SUITE 100
NAPLES FL
34109-4396
US

IV. Provider business mailing address

705 GORDONIA RD
NAPLES FL
34108-2656
US

V. Phone/Fax

Practice location:
  • Phone: 239-598-4004
  • Fax: 239-598-4713
Mailing address:
  • Phone: 239-566-8470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME0050721
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: