Individual
HARRIS MICHAEL GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1541 FLORIDA AVE, STE 200, MODESTO, CA 95350-4429
(209) 577-3388
(209) 523-0764
Mailing address
1541 FLORIDA AVE, STE 200, MODESTO, CA 95350-4429
(209) 577-3388
(209) 523-0764
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G19278
CA
2086S0127X
Trauma Surgery Physician
G19278
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020018719
RAILROAD MEDICARE
CA
01
—
CD069A
GROUP PTAN- MEDICARE
CA
01
—
CD169Z
INDIVIDUAL PTAN - MEDICARE
CA
01
—
ZZZ48224Z
MEDICARE IDENTIFICATION #
CA
Enumeration date
10/10/2005
Last updated
03/29/2011
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