Provider Demographics
NPI:1154558781
Name:GOODMAN, SAMANTHA (MD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:LYNN
Other - Last Name:HIRSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3929 SOUTH TREADWAY
Mailing Address - Street 2:SUITE B2
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-5409
Mailing Address - Country:US
Mailing Address - Phone:325-794-5421
Mailing Address - Fax:325-794-5426
Practice Address - Street 1:3926 S TREADAWAY BLVD STE B2
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-6939
Practice Address - Country:US
Practice Address - Phone:325-794-5421
Practice Address - Fax:325-794-5426
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3629207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine