Provider Demographics
NPI:1689654550
Name:GOODMAN, JORY FREDERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:JORY
Middle Name:FREDERIC
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 5271
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-5271
Mailing Address - Country:US
Mailing Address - Phone:310-435-8695
Mailing Address - Fax:424-999-0313
Practice Address - Street 1:468 N CAMDEN DR # 262J
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4507
Practice Address - Country:US
Practice Address - Phone:310-435-8695
Practice Address - Fax:424-999-0313
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2023-06-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG348022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A91631Medicare UPIN