Provider Demographics
NPI:1265588511
Name:GOODMAN, DAVID EDWARD (MD, MSE)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:EDWARD
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD, MSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PARKSIDE WAY
Mailing Address - Street 2:
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1346
Mailing Address - Country:US
Mailing Address - Phone:415-672-4427
Mailing Address - Fax:628-212-4700
Practice Address - Street 1:300 PROFESSIONAL CENTER DR STE 326
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-4334
Practice Address - Country:US
Practice Address - Phone:415-897-5400
Practice Address - Fax:415-892-9506
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80213208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice