Provider Demographics
NPI:1851357867
Name:GOODMAN, GILBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:
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 1:400 NEWPORT CENTER DR
Mailing Address - Street 2:SUITE 608
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7601
Mailing Address - Country:US
Mailing Address - Phone:949-644-3560
Mailing Address - Fax:949-644-3570
Practice Address - Street 1:400 NEWPORT CENTER DR
Practice Address - Street 2:SUITE 608
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7601
Practice Address - Country:US
Practice Address - Phone:949-644-3560
Practice Address - Fax:949-644-3570
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC38358207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA36911Medicare UPIN
CAWC38358DMedicare ID - Type Unspecified