Goodman, Gary M

Goodman, Gary M is an individual health care provider with primary practice located at 1 Childrens Pl , Saint Louis MO 63110-1002. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Pediatric Allergy/Immunology. Allopathic & Osteopathic Physicians / Pediatric Allergy/Immunology is his primary health care specialty. Goodman, Gary M can be contacted via phone (314) 454-2694.

Contact Information

Primary practice address
1 Childrens Pl Saint Louis MO 63110-1002
Phone: (314) 454-2694
Fax: (314) 454-2515
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 102527 Missouri
Allopathic & Osteopathic Physicians / Pediatric Allergy/Immunology 2080P0201X 102527 Missouri

Profile Details

NPI number 1811999485
LBN Legal business name Goodman, Gary M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 12th, 2005
Last updated Feb 19th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1811999485 NPPES
Missouri MEDICAID 204643001
Missouri MEDICAID ENROLLED

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