Provider Demographics
NPI:1861480923
Name:GOODMAN, KATHY E (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:E
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 DELRAY LAKES DR
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-1783
Mailing Address - Country:US
Mailing Address - Phone:757-268-5147
Mailing Address - Fax:
Practice Address - Street 1:4800 LINTON BLVD
Practice Address - Street 2:SUITE E300
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6584
Practice Address - Country:US
Practice Address - Phone:757-268-5147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 5514207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048523300Medicaid
FL80077Medicare PIN
FLE90304Medicare UPIN
FL048523300Medicaid