Provider Demographics
NPI:1396770848
Name:GOODMAN, DAVID SETH (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SETH
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 1:705 GORDONIA RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-2656
Mailing Address - Country:US
Mailing Address - Phone:239-566-8470
Mailing Address - Fax:
Practice Address - Street 1:9125 CORSEA DEL FONTANA WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-4396
Practice Address - Country:US
Practice Address - Phone:239-598-4004
Practice Address - Fax:239-598-4713
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050721207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04756ZMedicare ID - Type Unspecified
FLD61136Medicare UPIN