Provider Demographics
NPI:1295775328
Name:GOODMAN, STEVEN B (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:B
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 1:117 W BUNNY AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-2805
Mailing Address - Country:US
Mailing Address - Phone:805-543-4043
Mailing Address - Fax:805-543-7640
Practice Address - Street 1:1250 PEACH ST
Practice Address - Street 2:SUITE A
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2837
Practice Address - Country:US
Practice Address - Phone:805-543-4043
Practice Address - Fax:805-543-7640
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2015-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB235417OtherMEDICARE ID
CA00G532150OtherBLUE SHIELD OF CALIFORNIA
CA00G532150Medicaid
CA00G532150Medicaid
080109728Medicare PIN
080087466Medicare PIN
CADG556YMedicare PIN
CAWG53215KMedicare PIN
E02729Medicare UPIN
CA00G532150OtherBLUE SHIELD OF CALIFORNIA
CAWG53215HMedicare PIN