Healthcare Provider Details

I. General information

NPI: 1528398518
Provider Name (Legal Business Name): CYNTHIA DIANE GOODMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CYNTHIA DIANE COVENTON M.D,

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 W SPRING VALLEY RD
RICHARDSON TX
75081-4034
US

IV. Provider business mailing address

208 W SPRING VALLEY RD
RICHARDSON TX
75081-4034
US

V. Phone/Fax

Practice location:
  • Phone: 972-238-1976
  • Fax: 972-238-0456
Mailing address:
  • Phone: 972-238-1976
  • Fax: 972-238-0456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberJ1640
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: