Individual
DR. IAN P GOODMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12455 E 100TH ST N, OWASSO, OK 74055-4674
(918) 272-9464
(918) 272-9512
Mailing address
4802 S 109TH EAST AVE, TULSA, OK 74146-5822
(918) 392-1400
(918) 392-1488
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
27449
NE
207X00000X
Orthopaedic Surgery Physician
Primary
39030
OK
207X00000X
Orthopaedic Surgery Physician
ME133594
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14123871
CAQH
—
Enumeration date
03/29/2012
Last updated
05/11/2022
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