Basic Information
| Provider Information | |||||||||
| NPI: | 1336641828 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOODMAN | ||||||||
| FirstName: | FRANK | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 N AVENUE F | ||||||||
| Address2: | |||||||||
| City: | DENVER CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 793232741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8179929128 | ||||||||
| FaxNumber: | 9522099826 | ||||||||
| Practice Location | |||||||||
| Address1: | 415 N AVENUE F | ||||||||
| Address2: | |||||||||
| City: | DENVER CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 793232741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8065929501 | ||||||||
| FaxNumber: | 9185611289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2018 | ||||||||
| LastUpdateDate: | 07/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 6660 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.