Provider Demographics
NPI:1982666855
Name:GOODMAN, ROBERT LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEE
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1331 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2900
Mailing Address - Country:US
Mailing Address - Phone:707-584-7474
Mailing Address - Fax:707-584-7495
Practice Address - Street 1:1331 MEDICAL CENTER DR
Practice Address - Street 2:SUITE C
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2900
Practice Address - Country:US
Practice Address - Phone:707-584-7474
Practice Address - Fax:707-584-7495
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA26203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA24769Medicare UPIN
CA00262030Medicare ID - Type Unspecified