Individual
MR. NICHOLAS GRANT GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
4434 N 12TH ST, PHOENIX, AZ 85014-4507
(602) 242-8857
Mailing address
20717 N 59TH DR, GLENDALE, AZ 85308-6761
(623) 337-2689
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4697
AZ
Other
Enumeration date
04/20/2011
Last updated
03/11/2013
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