Provider Demographics
NPI:1346258472
Name:GOODMAN, HERBERT D (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:D
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 1:6726 E MONTECITO AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-2337
Mailing Address - Country:US
Mailing Address - Phone:480-994-1873
Mailing Address - Fax:
Practice Address - Street 1:11045 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4816
Practice Address - Country:US
Practice Address - Phone:602-944-4474
Practice Address - Fax:602-943-7829
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7607207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ267246001Medicaid
AZ08WCGSZ03Medicare ID - Type Unspecified