Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 01024689A | IN |
N | 207RG0300X | Geriatric Medicine | 01024689A | IN |
Y | 207RP1001X | Pulmonary Disease | 01024689A | IN |
NPI | 1508848433 |
---|---|
Provider Name | Mason R Goodman |
First Address | Indianapolis, IN 46268-3129 |
Second Address | Indianapolis, IN 46260-1954 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 10/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000081345 | BC/BS (01) | IN |
100062950 | (05) | IN |
290006483 | RAILROAD MEDICARE PIN (01) | |
CI0473 | RAILROAD GROUP (01) | |
E03581 | (02) | IN |