Individual
WARREN G GOODMAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 AINSWORTH DR, SUITE 115, PRESCOTT, AZ 86305-1667
(928) 778-1971
(928) 771-0638
Mailing address
1000 AINSWORTH DR, SUITE 115, PRESCOTT, AZ 86305-1667
(928) 778-1971
(928) 771-0638
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
15335
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
272443
—
AZ
Enumeration date
09/26/2005
Last updated
07/08/2007
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