Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | G063650 | CA |
NPI | 1003987355 |
---|---|
Provider Name | Daniel M Goodman |
First Address | Redding, CA 96049-6084 |
Second Address | Redding, CA 96003-4856 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 03/12/2012 |