Provider Demographics
NPI:1679758635
Name:GOODMAN, DANIEL FRED (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:FRED
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2211 BUSH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3121
Mailing Address - Country:US
Mailing Address - Phone:415-474-3333
Mailing Address - Fax:415-474-3939
Practice Address - Street 1:2211 BUSH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3121
Practice Address - Country:US
Practice Address - Phone:415-474-3333
Practice Address - Fax:415-474-3939
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG53124207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG531242Medicaid
OOG531240Medicare PIN
CAOOG531242Medicaid