MEDICARE: JONATHAN 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
1	208600000X	Surgery Physician	33921	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	:	1902845134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN GOODMAN MD

Provider Business Mailing Address
First Line	:	13188 N 103RD DR
Second Line	:	STE 206
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3064
Country	:	US
Telephone Number	:	623-972-3001
Fax Number	:	623-933-3045

Provider Business Practice Location Address
First Line	:	13188 N 103RD DR
Second Line	:	STE 206
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3064
Country	:	US
Telephone Number	:	623-972-3001
Fax Number	:	623-933-3045

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	03/03/2011

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Directions to “ JONATHAN GOODMAN MD” Practice Location

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