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NPI Code Detail

MEDICARE: MR. GEORGE ALLAN GOODMAN MD

MEDICARE:  MR. GEORGE ALLAN GOODMAN  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
12084P0800XPsychiatry PhysicianC28957CA

Other Identifiers

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

General Provider Information

NPI Number : 1487644811
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GEORGE ALLAN GOODMAN MD
Provider Business Mailing Address
First Line : 2635 CLEVELAND AVE
Second Line : STE 2
City : SANTA ROSA
State : CA
Zip : 95403-2981
Country : US
Telephone Number : 707-575-4868
Fax Number : 707-575-5870
Provider Business Practice Location Address
First Line : 2635 CLEVELAND AVE
Second Line : STE 2
City : SANTA ROSA
State : CA
Zip : 95403-2981
Country : US
Telephone Number : 707-575-4868
Fax Number : 707-575-5870
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2005
Last Update Date : 07/08/2007

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Directions to “ MR. GEORGE ALLAN GOODMAN MD” Practice Location

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