Provider Demographics
NPI:1881715043
Name:GOLDMAN, DAVID (JD, DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:
Credentials:JD, DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-7066
Mailing Address - Country:US
Mailing Address - Phone:217-793-3200
Mailing Address - Fax:217-793-5160
Practice Address - Street 1:4000 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-7066
Practice Address - Country:US
Practice Address - Phone:217-793-3200
Practice Address - Fax:217-793-5160
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0961142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry