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General NPI Number Information
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NPI Number | 1487890950
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Entity Type | Organization
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Legal Business Name | JORY F. GOODMAN MD PC
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Dates
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Enumeration Date | 01/05/2009
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Last Update Date | 01/05/2009
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Provider Practice Location Address
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Address Line | 9730 WILSHIRE BLVD. SUITE 216A
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-2030
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Country | US
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Telephone | 310-858-1700
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Fax | 310-887-4708
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Provider Business Mailing Address
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Address Line | 9730 WILSHIRE BLVD. SUITE 216A
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-2030
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Country | US
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Telephone | 310-858-1700
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Fax | 310-887-4708
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Authorized Official
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Title or Position | PRESIDENT
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Name | JORY FREDERIC GOODMAN
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Credential | MD
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Telephone | 310-858-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G34802
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License Number State | CA
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