DR. GARY M GOODMAN (NPI# 1811999485) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811999485 |
| Entity Type | Individual |
| Full Name | DR. GARY M GOODMAN |
| Credential | MD |
| Practice Address |
1 Childrens Pl Saint Louis MO 63110-1002 |
| Mailing Address |
456 N New Ballas Rd Ste 129 Saint Louis MO 63141-6812 |
| Practice Telephone | 3144542694 |
| Practice Fax Number | 3144542515 |
| Mailing Telephone | 3145691881 |
| Mailing Fax Number | 3145693277 |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2020-02-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | 102527 | MO | Allopathic & Osteopathic Physicians |
| Y | 2080P0201X |
Pediatrics Specialization: Pediatric Allergy/Immunology |
102527 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 204643001 | 05 | |
| IL | ENROLLED | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477574978 | Gary Sean Goodman | Pharmacist | 6000 Quiet Glow Ave, Las Vegas, NV 89139-6422 | 2006-07-21 |
| 1982669024 | Gary R Goodman | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 22250 Providence Dr Ste 606, Southfield, MI 48075-6214 | 2006-04-20 |
| 1629353735 | Gary Goodman | Case Manager/Care Coordinator | 64 Industrial Park Rd, Plymouth, MA 02360-4881 | 2011-10-20 |
| 1992988869 | Gary H Goodman | Dentist | 3455 Main St, Springfield, MA 01107-1147 | 2007-12-13 |
| 1255402251 | Gary E. Goodman | Internal Medicine | 1221 Madison St, Seattle, WA 98104-3588 | 2006-11-13 |
| 1588758551 | Gary Goodman | Pediatrics | 455 S Main St, Orange, CA 92868-3835 | 2006-10-03 |
| 1740232172 | Gary A Goodman | Emergency Medicine | 1401 W Seminole Blvd, Central Florida Regional Hospital, Dept of Emerg. Med., Sanford, FL 32771-6743 | 2006-05-16 |
| 1972581841 | Gary R Goodman | Urology | 3520 E 15th St, Suite 200, Loveland, CO 80538-8938 | 2006-01-02 |
| 1316930381 | Gary Neal Goodman | Psychologist | 11110 N Tatum Blvd, Suite 103, Phoenix, AZ 85028-1607 | 2005-08-25 |
| 1598758617 | Gary Richard Goodman | Podiatrist | 2350 Sunset Point Rd, Suite A, Clearwater, FL 33765-1443 | 2005-08-24 |
| Street Address |
1 CHILDRENS PL |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63110-1002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669476495 | William Lee Johnson | Pediatrics | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2005-06-09 |
| 1114527033 | Kristin Kueper | Dietitian, Registered | 1 Childrens Pl, Saint Louis, MO 63110-1081 | 2020-10-29 |
| 1609474055 | Courtney Tompkins | Audiologist | 1 Childrens Pl, Saint Louis, MO 63110-1081 | 2020-10-16 |
| 1164036851 | Andrea Bumb | Nurse Practitioner | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-09-01 |
| 1235741513 | Shannon Ries | Nurse Practitioner | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-08-19 |
| 1144832320 | Lacey Bender | Nurse Practitioner | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-08-19 |
| 1699386417 | Kristen Bagby | Nurse Practitioner | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-08-14 |
| 1720696115 | Abigail Patricia Klatch | Nurse Practitioner | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-07-21 |
| 1518575422 | St Louis Childrens Hospital | Clinical Medical Laboratory | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-07-16 |
| 1730707068 | Alyssa Lavalle | Nurse Practitioner | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-07-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659971992 | Carrie Ellen Smith | Nurse Practitioner | Mailstop 90-00-174, One Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-10-27 |
| 1881210466 | Michelle Amanda Freilich | Internal Medicine | Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-06-19 |
| 1245856046 | Jeevin Shahi | Radiology | 3685 Vista Avenue, Center for Radiation Medicine, St. Louis, MO 63110 | 2020-06-18 |
| 1497371314 | Wilson Eduardo Rodriguez | Student in an Organized Health Care Education/Training Program | 1008 S. Spring, St Louis, MO 63110 | 2020-06-17 |
| 1578184065 | Kathryn Kay Lindsay | Registered Nurse | Saint Louis University Dept of Surgery, 3635 Vista Ave 3dt, St Louis, MO 63110 | 2020-05-06 |
| 1881232700 | Ashley Diane Pace | Nurse Practitioner | 1 Parkview Place, Shoenberg 6900, St. Louis, MO 63110 | 2019-12-11 |
| 1619520418 | Krithika Damodar Shenoy | Pathology | 660 Euclid Avenue, One Barnes Jewish Hospital Plaza, St. Louis, MO 63110 | 2019-07-20 |
| 1467912550 | Ian Ferguson | Dermatology | 660 S Euclid Ave., Cb 8123, St. Louis, MO 63110 | 2019-03-23 |
| 1760978688 | Ihab Hassanieh | Student in an Organized Health Care Education/Training Program | 33660 Vista Ave, St. Louis, MO 63110 | 2018-07-03 |
| 1336634500 | Martin K Mwangi | Pediatrics | 1 Childrens Place, 3s34, St. Louis, M, MO 63110 | 2018-06-28 |
| Find all providers in zip 63110 | ||||
| Taxonomy Code | 2080P0201X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Allergy/Immunology |
| A pediatrician who specializes in the diagnosis and treatment of allergies, allergic reactions, and immunologic diseases in children. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: title modified, definition added, source added] Additional Resources: A Certification of Special Qualifications (CSQ) is issued by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649499401 | St Louis University | Pediatrics | 1465 S Grand Blvd, Saint Louis, MO 63104-1003 | 2007-04-24 |
| 1619993920 | Gordon R Bloomberg | Pediatrics | 1 Childrens Pl, Ste 5s30, Saint Louis, MO 63110-1002 | 2006-07-14 |
| 1821037334 | Ray S Davis | Pediatrics | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2006-06-06 |
| 1578510509 | Lisa V Suffian | Pediatrics | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2006-05-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275828717 | Michael Ian Derrick | Pediatrics | 2401 Gillham Rd, Kansas City, MO 64108-4619 | 2011-06-13 |
| 1073561742 | Paul Joseph Dowling Jr. | Pediatrics | 2401 Gillham Rd, Kansas City, MO 64108-4619 | 2006-05-05 |
| City | SAINT LOUIS |
| Zip Code | 63110 |
Please comment or provide details below to improve the information on DR. GARY M GOODMAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.