Provider Demographics
NPI:1952553885
Name:GOODMAN, ANDREW
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2046 FOREST LN STE 180
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-7939
Mailing Address - Country:US
Mailing Address - Phone:972-494-1419
Mailing Address - Fax:972-494-2069
Practice Address - Street 1:2046 FOREST LN STE 180
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-7939
Practice Address - Country:US
Practice Address - Phone:972-494-1419
Practice Address - Fax:972-494-2069
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11008111NI0013X
TX1140602363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner