Provider Demographics
NPI:1598758617
Name:GOODMAN, GARY RICHARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:RICHARD
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2350 SUNSET POINT RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1443
Mailing Address - Country:US
Mailing Address - Phone:727-796-0565
Mailing Address - Fax:727-796-7464
Practice Address - Street 1:2350 SUNSET POINT RD
Practice Address - Street 2:SUITE A
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1443
Practice Address - Country:US
Practice Address - Phone:727-796-0565
Practice Address - Fax:727-796-7464
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1435213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT55545Medicare UPIN
FL87785WMedicare PIN