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General NPI Number Information
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NPI Number | 1174558407
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Entity Type | Individual
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Provider Name | MICHAEL P GOODMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 07/28/2008
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Provider Practice Location Address
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Address Line | 635 ANDERSON RD SUITE 12B
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City | DAVIS
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State | CA
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Zip | 95616-3505
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Country | US
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Telephone | 530-753-2787
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Fax | 530-750-0221
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Provider Business Mailing Address
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Address Line | 635 ANDERSON RD SUITE 12B
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City | DAVIS
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State | CA
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Zip | 95616-3505
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Country | US
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Telephone | 530-753-2787
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Fax | 530-750-0221
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | C31721
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License Number State | CA
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