Provider Demographics
NPI:1770588113
Name:GOODMAN, DAVID S (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2820 NORTHUP WAY
Mailing Address - Street 2:STE 200
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-1498
Mailing Address - Country:US
Mailing Address - Phone:253-588-7911
Mailing Address - Fax:
Practice Address - Street 1:2820 NORTHUP WAY
Practice Address - Street 2:STE 200
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1498
Practice Address - Country:US
Practice Address - Phone:425-822-1300
Practice Address - Fax:425-822-1301
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD0002655207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1118652Medicaid
B77197Medicare UPIN
WA1118652Medicaid