Provider Demographics
NPI:1154448520
Name:GOODMAN, STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 WISCONSIN ST
Mailing Address - Street 2:POTRERO HILL HEALTH CTR.
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-3328
Mailing Address - Country:US
Mailing Address - Phone:415-920-1221
Mailing Address - Fax:415-550-1639
Practice Address - Street 1:1050 WISCONSIN ST
Practice Address - Street 2:POTRERO HILL HEALTH CTR.
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-3328
Practice Address - Country:US
Practice Address - Phone:415-920-1221
Practice Address - Fax:415-550-1639
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52361207RI0200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Not Answered363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
003384OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER
E24979Medicare UPIN