Provider Demographics
NPI:1407064504
Name:GOODMAN, DAVID M (MED)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23480 SANABRIA LOOP
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-5380
Mailing Address - Country:US
Mailing Address - Phone:401-692-6549
Mailing Address - Fax:
Practice Address - Street 1:23480 SANABRIA LOOP
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-5380
Practice Address - Country:US
Practice Address - Phone:401-692-6549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 10927235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist