Provider Demographics
NPI:1922009026
Name:GOODMAN, DAVID AARON (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:AARON
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 1:108 W TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-4221
Mailing Address - Country:US
Mailing Address - Phone:870-732-1191
Mailing Address - Fax:870-732-4091
Practice Address - Street 1:108 W TYLER AVE
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4221
Practice Address - Country:US
Practice Address - Phone:870-732-1191
Practice Address - Fax:870-732-4091
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-0948208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR129454001Medicaid
G27179Medicare UPIN
AR5K097Medicare ID - Type Unspecified