Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 23013 | CO |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 76-180 | NM |
NPI | 1225093818 |
---|---|
Provider Name | Robert F Goodman |
First Address | Durango, CO 81301-7300 |
Second Address | Durango, CO 81301-7300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 22/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01230135 | (05) | CO |
D28312 | (02) |