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General NPI Number Information
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NPI Number | 1275760894
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Entity Type | Individual
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Provider Name | ELIZABETH LEIGH GOODMAN MD
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Gender | Female
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Dates
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Enumeration Date | 06/22/2009
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Last Update Date | 01/08/2013
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Provider Practice Location Address
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Address Line | 200 MEDICAL PLZ 420
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City | LOS ANGELES
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State | CA
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Zip | 90095-0001
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Country | US
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Telephone | 310-794-9809
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Fax | 310-206-3551
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Provider Business Mailing Address
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Address Line | 3181 SW SAM JACKSON PARK RD MAIL CODE OP-30
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City | PORTLAND
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State | OR
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Zip | 97239-3011
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Country | US
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Telephone |
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD155346
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A122813
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License Number State | CA
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