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General NPI Number Information
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NPI Number | 1609018860
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Entity Type | Individual
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Provider Name | MARK QUINCY GOODMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/01/2009
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 1253 NW CANAL BLVD
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City | REDMOND
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State | OR
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Zip | 97756-1334
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Country | US
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Telephone | 541-548-8131
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Fax | 541-526-6608
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Provider Business Mailing Address
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Address Line | 1303 NE CUSHING DR STE 100
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City | BEND
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State | OR
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Zip | 97701
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Country | US
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Telephone | 541-908-1217
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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 | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | MD160709
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207PS0010X
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Taxonomy Name | Sports Medicine (Emergency Medicine) Physician
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License Number | MD160709
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD160709
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License Number State | OR
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