Individual
DR. GARY M GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 CHILDRENS PL, SAINT LOUIS, MO 63110-1002
(314) 454-2694
(314) 454-2515
Mailing address
456 N NEW BALLAS RD, STE 129, SAINT LOUIS, MO 63141-6812
(314) 569-1881
(314) 569-3277
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
102527
MO
2080P0201X
Pediatric Allergy/Immunology Physician
Primary
102527
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204643001
—
MO
05
—
ENROLLED
—
IL
Enumeration date
08/12/2005
Last updated
02/19/2020
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