Individual
DR. GARY R GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3520 E 15TH ST, SUITE 200, LOVELAND, CO 80538-8938
(970) 669-9100
(970) 669-0440
Mailing address
3520 E 15TH ST, SUITE 200, LOVELAND, CO 80538-8938
(970) 669-9100
(970) 669-0440
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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