Individual
MR. MARK STEPHEN GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2900 DAGGETT AVE, KLAMATH FALLS, OR 97601-7101
(541) 884-1371
(541) 882-3862
Mailing address
2900 DAGGETT AVE, KLAMATH FALLS, OR 97601-7101
(541) 884-1371
(541) 882-3862
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD20502
OR
2085R0204X
Vascular & Interventional Radiology Physician
MD20502
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150322
—
OR
05
—
XPY191725
—
CA
Enumeration date
09/30/2005
Last updated
09/28/2007
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