Provider Demographics
NPI:1871698613
Name:GOODMAN, JEFFREY ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
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 1:1879 NIGHTINGALE LN STE C2
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-4363
Mailing Address - Country:US
Mailing Address - Phone:352-745-7776
Mailing Address - Fax:352-742-7750
Practice Address - Street 1:1879 NIGHTINGALE LN STE C2
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4363
Practice Address - Country:US
Practice Address - Phone:352-742-7776
Practice Address - Fax:352-742-7750
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66294207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10008741OtherMEDICARE RAILROAD
FL25425OtherBLUE CROSS
FL375405700Medicaid
FLF84800Medicare UPIN
FL25425ZMedicare PIN