Individual
DR. GARY R GOODMAN
Active
Individual
DR. GARY R GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
36761
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01367614
—
CO
01
—
P00944736
MEDICARE RAILROAD CARRIER PTAN
CO
Enumeration date
01/02/2006
Last updated
01/26/2015
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