Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD2006-0823 | NM |
Y | 111NI0900X | Internist | MD2006-0823 | NM |
N | 207RG0300X | Geriatric Medicine | MD2006-0823 | NM |
N | 207RH0002X | Hospice and Palliative Medicine | MD2006-0823 | NM |
NPI | 1013056282 |
---|---|
Provider Name | Tamara Goodman |
First Address | Albuquerque, NM 87109-4495 |
Second Address | Albuquerque, NM 87109-4495 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 18/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22705325 | (05) | NM |