Individual
DR. GORDON D. GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
1106 DRUID RD S, SUITE 302, CLEARWATER, FL 33756-3846
(727) 441-3711
Mailing address
PO BOX 917368, ORLANDO, FL 32891-0001
(727) 793-9300
(727) 793-0052
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME36216
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
068313200
—
FL
01
—
62249
BCBS
FL
Enumeration date
10/27/2005
Last updated
12/02/2011
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