Provider Demographics
NPI:1861448177
Name:GOODMAN, SHAWN (MD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9735 SW SHADY LANE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223
Mailing Address - Country:US
Mailing Address - Phone:503-634-4436
Mailing Address - Fax:503-635-7356
Practice Address - Street 1:9735 SW SHADY LANE
Practice Address - Street 2:SUITE 203
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223
Practice Address - Country:US
Practice Address - Phone:503-634-4436
Practice Address - Fax:503-635-7356
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13455207W00000X
ORMD13435207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR121533Medicaid
OR121533Medicaid
ORC91060Medicare UPIN