Healthcare Provider Details

I. General information

NPI: 1407838832
Provider Name (Legal Business Name): JAMES S. GOODMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12231 ACADEMY RD NE STE 301
ALBUQUERQUE NM
87111-7239
US

IV. Provider business mailing address

12231 ACADEMY RD NE STE 301
ALBUQUERQUE NM
87111-7239
US

V. Phone/Fax

Practice location:
  • Phone: 505-830-2900
  • Fax:
Mailing address:
  • Phone: 505-830-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number97-61
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: