Provider Demographics
NPI:1144280454
Name:GOLDMAN, ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:GOLDMAN
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 1:5810 S 300 E
Mailing Address - Street 2:# 300
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6178
Mailing Address - Country:US
Mailing Address - Phone:801-314-2346
Mailing Address - Fax:801-314-2345
Practice Address - Street 1:5810 S 300 E
Practice Address - Street 2:# 300
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6178
Practice Address - Country:US
Practice Address - Phone:801-314-2346
Practice Address - Fax:801-314-2345
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT50-00856-12052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTAG5737866OtherDEA LICENSE