Individual
DR. JACK GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
833 CHESTNUT ST STE 220, PHILADELPHIA, PA 19107-4405
(215) 955-8465
Mailing address
833 CHESTNUT ST STE 220, PHILADELPHIA, PA 19107-4405
(215) 955-8465
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MT23106
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
04/05/2024
Last updated
06/12/2024
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