Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 49175 | WI |
Y | 204F00000X | Transplant Surgeon | MD.28959 | AL |
NPI | 1770530776 |
---|---|
Provider Name | Jeremy Goodman |
First Address | Birmingham, AL 35255-5310 |
Second Address | Birmingham, AL 35249-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 28/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H42929 | (02) |