Provider Demographics
NPI:1841400272
Name:GOODMAN, JILL C (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:C
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2769 HEARTLAND DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2732
Mailing Address - Country:US
Mailing Address - Phone:319-337-3139
Mailing Address - Fax:319-545-4570
Practice Address - Street 1:2769 HEARTLAND DR
Practice Address - Street 2:SUITE 201
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2732
Practice Address - Country:US
Practice Address - Phone:319-337-3139
Practice Address - Fax:319-545-4570
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA39106207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology