Provider Demographics
NPI:1710954060
Name:GOODMAN, JAMES BERNHARDT (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BERNHARDT
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 1:2505 CHANTILLY CT
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:TX
Mailing Address - Zip Code:75032-1909
Mailing Address - Country:US
Mailing Address - Phone:972-771-0502
Mailing Address - Fax:
Practice Address - Street 1:2505 CHANTILLY CT
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:TX
Practice Address - Zip Code:75032-1909
Practice Address - Country:US
Practice Address - Phone:972-771-0502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6009207QA0505X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131468408Medicaid
TX131468407Medicaid
TX131468408Medicaid
TX131468407Medicaid
8D9365Medicare ID - Type Unspecified