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General NPI Number Information
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NPI Number | 1689654550
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Entity Type | Individual
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Provider Name | JORY FREDERIC GOODMAN MD
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Gender | Male
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Dates
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Enumeration Date | 01/18/2006
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 468 N CAMDEN DR # 262J
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4507
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Country | US
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Telephone | 310-435-8695
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Fax | 424-999-0313
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Provider Business Mailing Address
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Address Line | PO BOX 5271
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City | BEVERLY HILLS
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State | CA
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Zip | 90209-5271
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Country | US
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Telephone | 310-435-8695
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Fax | 424-999-0313
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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 | 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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