Individual
JAY MAURY GOODMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3024 SE WOODSTOCK BLVD, PORTLAND, OR 97202-8136
(541) 260-2399
Mailing address
PO BOX 82234, PORTLAND, OR 97282-0234
(541) 260-2399
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD09880
OR
Other
Enumeration date
05/07/2021
Last updated
05/07/2021
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