Individual
MASON R GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1801 N SENATE BLVD STE 230, INDIANAPOLIS, IN 46202-1252
(317) 962-5820
(317) 962-3916
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
01024689A
IN
207KA0200X
Allergy Physician
01024689A
IN
207R00000X
Internal Medicine Physician
Primary
01024689A
IN
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
01024689A
IN
207RP1001X
Pulmonary Disease Physician
01024689A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000081345
BC/BS
IN
05
—
100062950
—
IN
01
—
1102212356
ANTHEM PTAN
IN
01
—
290006483
RAILROAD MEDICARE PIN
—
01
—
CI0473
RAILROAD GROUP
—
Enumeration date
11/16/2005
Last updated
03/08/2025
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