Provider Demographics
NPI:1407838832
Name:GOODMAN, JAMES S (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:S
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12231 ACADEMY RD NE STE 301
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7239
Mailing Address - Country:US
Mailing Address - Phone:505-830-2900
Mailing Address - Fax:
Practice Address - Street 1:12231 ACADEMY RD NE STE 301
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-7239
Practice Address - Country:US
Practice Address - Phone:505-830-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM97-612084P0800X, 2084P0800X
CAG421972084P0800X
MS173892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000Q4394Medicaid
943270879OtherTRICARE
943270879OtherTRICARE
NM000Q4394Medicaid
A48851Medicare UPIN
NM000Q4394Medicaid