Provider Demographics
NPI:1821255936
Name:GOODMAN, STEVEN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ROBERT
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 1:715 S COWLEY ST
Mailing Address - Street 2:SUITE #224
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1375
Mailing Address - Country:US
Mailing Address - Phone:509-473-6706
Mailing Address - Fax:509-473-6704
Practice Address - Street 1:711 S COWLEY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1330
Practice Address - Country:US
Practice Address - Phone:509-473-6706
Practice Address - Fax:509-473-6704
Is Sole Proprietor?:No
Enumeration Date:2008-05-18
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023921208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1085224Medicaid
E29495Medicare UPIN
WA1085224Medicaid