MEDICARE: EDWARD L GOODMAN M.D.

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	207RI0200X	Infectious Disease Physician	D6437	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245215466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD L GOODMAN M.D.

Provider Business Mailing Address
First Line	:	8230 WALNUT HILL LN STE 414
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4469
Country	:	US
Telephone Number	:	214-691-8306
Fax Number	:	214-691-3967

Provider Business Practice Location Address
First Line	:	8230 WALNUT HILL LN STE 414
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4469
Country	:	US
Telephone Number	:	214-691-8306
Fax Number	:	214-691-3967

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	08/09/2011

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Directions to “ EDWARD L GOODMAN M.D.” Practice Location

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