Individual
DR. FRED L GOODMAN JR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
MARINE CORPS AIR STATION, BUILDING 1175, BOX 99116, YUMA, AZ 85369-9116
(928) 269-6091
Mailing address
NAVAL HOSPITAL CAMP PENDLETON, BUILDING H-100, CAMP PENDLETON, CA 92055-5191
(928) 269-6091
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME0074276
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME0074276
MEDICAL LICENSE
FL
Enumeration date
10/31/2005
Last updated
07/08/2007
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