Provider Demographics
NPI:1841260734
Name:GOODMAN, IRA J (MD)
Entity type:Individual
Prefix:
First Name:IRA
Middle Name:J
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 W GORE ST
Mailing Address - Street 2:SUITE 406
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1044
Mailing Address - Country:US
Mailing Address - Phone:407-210-1320
Mailing Address - Fax:321-202-2582
Practice Address - Street 1:100 W GORE ST
Practice Address - Street 2:SUITE 406
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1044
Practice Address - Country:US
Practice Address - Phone:407-210-1320
Practice Address - Fax:321-202-2582
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME41137207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272038800Medicaid
FL47554VMedicare PIN
FL272038800Medicaid
FL47554YMedicare PIN