Provider Demographics
NPI:1154498244
Name:GOODMAN, ALLAN L (MD)
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:L
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7368
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-7368
Mailing Address - Country:US
Mailing Address - Phone:714-571-5000
Mailing Address - Fax:714-571-5055
Practice Address - Street 1:7304 E DEER VALLEY RD
Practice Address - Street 2:SUITE 105
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7450
Practice Address - Country:US
Practice Address - Phone:480-264-2400
Practice Address - Fax:480-264-2410
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360571132085R0202X
AZ356262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036057113Medicaid
AZ415248Medicaid
IL4923631OtherBCBS ID
L76377Medicare PIN
C43369Medicare UPIN
AZZ128622Medicare PIN
IL4923631OtherBCBS ID