Provider Demographics
NPI:1740232172
Name:GOODMAN, GARY A (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
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 1:1401 W SEMINOLE BLVD
Mailing Address - Street 2:CENTRAL FLORIDA REGIONAL HOSPITAL, DEPT OF EMERG. MED.
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-6743
Mailing Address - Country:US
Mailing Address - Phone:407-321-4500
Mailing Address - Fax:
Practice Address - Street 1:1401 W SEMINOLE BLVD
Practice Address - Street 2:CENTRAL FLORIDA REGIONAL HOSPITAL, DEPT OF EMERG. MED.
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-6743
Practice Address - Country:US
Practice Address - Phone:407-321-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231673207P00000X
FLME95652207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI54199Medicare UPIN
FL54253OtherBCBS
FLU7531YMedicare PIN