MEDICARE: ALLAN H. GOODMAN, MD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	A20877	CA

General Provider Information

NPI Number	:	1184649832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLAN H. GOODMAN, MD INC

Provider Business Mailing Address
First Line	:	1219 HIDDEN MOUNTAIN DR
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92019-3640
Country	:	US
Telephone Number	:	858-292-5151
Fax Number	:

Provider Business Practice Location Address
First Line	:	1219 HIDDEN MOUNTAIN DR
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92019-3640
Country	:	US
Telephone Number	:	858-292-5151
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ALLAN H GOODMAN
Credential	:	MD
Telephone Number	:	619-443-0282

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	03/14/2018

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