National Provider Identifier Database

GARY M GOODMAN, MD – NPI #1811999485
Pediatric Allergy/Immunology


Contact Information

GARY M GOODMAN, MD
1 CHILDRENS PL
SAINT LOUIS, MO63110-1002
Phone: 314-454-2694
Fax: 314-454-2515
Website:
Specialty Taxonomy Code
* Pediatric Allergy/Immunology 2080P0201X
Pediatrics 208000000X

* Indicates primary specialty

NPI Profile & details for GARY M GOODMAN

NPI Number 1811999485
Credentials MD
Entity Individual
Enumeration date 08/12/2005
Last updated 02/19/2020 - About 6 years ago
Sole proprietor1 No
Identifiers
  • MO License #: 102527
  • IL Medicaid: ENROLLED
  • MO Medicaid: 204643001
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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