Provider Demographics
NPI:1487637997
Name:GOODMAN, DAVID L (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3601 S CLARKSON
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3946
Mailing Address - Country:US
Mailing Address - Phone:303-761-4343
Mailing Address - Fax:303-761-0943
Practice Address - Street 1:3601 S CLARKSON
Practice Address - Street 2:SUITE 200
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3946
Practice Address - Country:US
Practice Address - Phone:303-761-4343
Practice Address - Fax:303-761-0943
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2011-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO31598207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01315985Medicaid
COF7768Medicare ID - Type Unspecified
F26370Medicare UPIN