MEDICARE: BRITTON GOODMAN D.O.

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
2	207Q00000X	Family Medicine Physician	008113	AZ

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	:	1821522608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTON GOODMAN D.O.

Provider Business Mailing Address
First Line	:	2345 E SOUTHERN AVE STE 101
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-5419
Country	:	US
Telephone Number	:	480-893-2345
Fax Number	:	480-926-0495

Provider Business Practice Location Address
First Line	:	2345 E SOUTHERN AVE STE 101
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-5419
Country	:	US
Telephone Number	:	804-893-2345
Fax Number	:	480-926-0495

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

Provider Enumeration Date	:	04/18/2017
Last Update Date	:	05/27/2020

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Directions to “ BRITTON GOODMAN D.O.” Practice Location

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