Provider Demographics
NPI:1497718795
Name:GOODMAN, RALPH C (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:C
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:PO BOX 2699
Mailing Address - Street 2:ATTN: SHMG/HPE
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-278-3742
Mailing Address - Fax:850-278-3779
Practice Address - Street 1:7720 US HIGHWAY 98 W
Practice Address - Street 2:STE 230
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-7230
Practice Address - Country:US
Practice Address - Phone:850-278-3742
Practice Address - Fax:850-278-3779
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME125346207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN460001521OtherRAILROAD MEDICARE
MS17806Medicaid
AR112825001Medicaid
MO202389508Medicaid
TN3166103Medicaid
MS17806Medicaid
3166104Medicare ID - Type Unspecified