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General NPI Number Information
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NPI Number | 1396016465
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Entity Type | Individual
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Provider Name | CHARLES FREDRICK GOODMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/22/2012
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Last Update Date | 01/22/2012
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Provider Practice Location Address
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Address Line | 15256 BELLECOURT
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City | SARATOGA
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State | CA
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Zip | 95070-6407
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Country | US
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Telephone | 408-395-0818
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Fax | 801-315-8383
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Provider Business Mailing Address
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Address Line | 15256 BELLECOURT
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City | SARATOGA
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State | CA
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Zip | 95070-6407
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Country | US
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Telephone | 408-395-0818
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Fax | 801-315-8383
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | G27751
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License Number State | CA
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