Provider Demographics
NPI:1942321930
Name:GOODMAN, IRA LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:LEE
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 1:8390 E VIA DE VENTURA
Mailing Address - Street 2:SUITE F-110
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3188
Mailing Address - Country:US
Mailing Address - Phone:602-741-3502
Mailing Address - Fax:888-678-3543
Practice Address - Street 1:4316 CORTE DE LA FONDA
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2126
Practice Address - Country:US
Practice Address - Phone:602-741-3502
Practice Address - Fax:888-678-3543
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ117472083P0500X
CAG404452083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine