Provider Demographics
NPI:1295708584
Name:GOODMAN, BRADLY SEAN (MD)
Entity type:Individual
Prefix:
First Name:BRADLY
Middle Name:SEAN
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 1:1801 GADSDEN HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3134
Mailing Address - Country:US
Mailing Address - Phone:205-838-3900
Mailing Address - Fax:205-838-3906
Practice Address - Street 1:1801 GADSDEN HIGHWAY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3134
Practice Address - Country:US
Practice Address - Phone:205-838-3900
Practice Address - Fax:205-838-3906
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120607208100000X
AL00018155208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL23043Medicaid
AL51023043OtherBLUE CROSS BLUE SHIELD
AL51023043OtherBLUE CROSS BLUE SHIELD
AL23043Medicaid