MEDICARE: JACQUELINE GOODMAN URDANG MD

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1346177417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE GOODMAN URDANG MD

Provider Business Mailing Address
First Line	:	2321 21ST ST
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-4279
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 BARNES JEWISH HOSPITAL PLZ
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1003
Country	:	US
Telephone Number	:	314-362-1291
Fax Number	:

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

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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