Doctor Name: | DR. JEREMY L GOODWIN |
NPI Number: | 1366547614 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MS, MD |
License Number: | G76323 |
Business Practice Address: | 110 W Castle St Mount Shasta, CA - 960672206 |
Business Phone Number: | 5309261039 |
Business Fax Number: | 5309262217 |
Mailing Address: | 303 N Adams Dr, MOUNT SHASTA |
State: | CA |
Postal Code: | 960679677 |
Phone Number: | 5309261039 |
Fax Number: | 5309262217 |
NPI Enumeration Date: | 09/13/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2084A0401X |
License Number: | G76323 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Psychiatry & Neurology |
Taxonomy Specialization: | Addiction Medicine |
Taxonomy Definition: | A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |