Provider Demographics
NPI:1790353712
Name:GOODMAN, JARED VEGA (MD, PHD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:VEGA
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD, PHD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:660 S. EUCLID AVENUE
Mailing Address - Street 2:CAMPUS BOX 8111
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110
Mailing Address - Country:US
Mailing Address - Phone:314-362-3296
Mailing Address - Fax:314-362-9462
Practice Address - Street 1:1 BARNES JEW HOSP PLZ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-362-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20210219502084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology