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Individual

DR. DOUGLAS E GOODMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
5325 FARAON ST, SAINT JOSEPH, MO 64506-3488
(816) 271-6575
(816) 271-6139
Mailing address
PO BOX 8252, SAINT JOSEPH, MO 64508-8252
(816) 271-6575
(816) 271-6139

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
0432989
KS
2085R0202X
Diagnostic Radiology Physician
Primary
R6C87
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200334530A
KS
05
202192837
MO
01
203405
BCBS KS FOR MO LOCATION
KS
01
35032011
BCBS KANSAS CITY MO
MO
01
P00154639
RR MEDICARE GROUP CK7871
MO
Enumeration date
02/20/2006
Last updated
05/23/2008
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