Provider Demographics
NPI:1164411799
Name:GOODMAN, RICHARD M (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:M
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:21110 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1227
Mailing Address - Country:US
Mailing Address - Phone:305-466-0030
Mailing Address - Fax:305-466-4755
Practice Address - Street 1:21110 BISCAYNE BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1227
Practice Address - Country:US
Practice Address - Phone:305-466-0030
Practice Address - Fax:305-466-4755
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME21487207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
591322663AOtherHUMANA
92713OtherHEALTH OPTIONS
FL058731100Medicaid
5487107OtherFIRST HEATLH
92713OtherBLUE CROSS BLUE SHIELD
408111337OtherMEDICARE RAILROAD
2045636OtherAETNA
20544OtherNEIGHBORHOOD HEALTH PLAN
1117963OtherCIGNA
FL058731100Medicaid
92713OtherHEALTH OPTIONS