Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 21521 | TX |
NPI | 1467638007 |
---|---|
Provider Name | Dr. Edward Dulaney Goodman |
First Address | Dallas, TX 75287-5227 |
Second Address | Dallas, TX 75231-3768 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2008 |
Last Update Date | 14/01/2008 |