Individual
DR. DENNIS STEPHEN GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
715 ST RT CC, ROLLA, MO 65401
(573) 308-7386
(573) 341-5300
Mailing address
PO BOX 918, ROLLA, MO 65402
(573) 341-5300
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
RSB71
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080052033
RAILROAD MEDICARE
MO
05
—
241605948
—
MO
Enumeration date
10/18/2006
Last updated
02/22/2008
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