Provider Demographics
NPI:1811258775
Name:GOODMAN, DAVID ALLEN (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLEN
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 1:3939 MONONA DR
Mailing Address - Street 2:101
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-1175
Mailing Address - Country:US
Mailing Address - Phone:608-772-0634
Mailing Address - Fax:
Practice Address - Street 1:3939 MONONA DR
Practice Address - Street 2:101
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-1175
Practice Address - Country:US
Practice Address - Phone:608-772-0634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22605-0202083X0100X
FLME1122102083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine