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General NPI Number Information
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NPI Number | 1386611564
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Entity Type | Individual
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Provider Name | BRIAN GOODMAN MD
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Gender | Male
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Dates
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Enumeration Date | 03/07/2006
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Last Update Date | 04/03/2024
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Provider Practice Location Address
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Address Line | 201 E NICOLLET BLVD FAIRVIEW RIDGES HOSPITAL
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City | BURNSVILLE
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State | MN
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Zip | 55337
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Country | US
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Telephone | 952-892-2021
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Fax | 952-892-2670
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Provider Business Mailing Address
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Address Line | 7301 OHMS LANE SUITE 650
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City | EDINA
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State | MN
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Zip | 55439
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Country | US
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Telephone | 952-835-9880
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Fax | 952-857-1554
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 55046-020
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 45985
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License Number State | MN
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