Doctor Name: | MR. GREGORY THOMAS GOODWIN |
NPI Number: | 1427197920 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | PA14029 |
Business Practice Address: | 9024 Sniktaw Ln Fort Jones, CA - 960329408 |
Business Phone Number: | 5304684470 |
Business Fax Number: | 5304684478 |
Mailing Address: | 9024 Sniktaw Ln, FORT JONES |
State: | CA |
Postal Code: | 960329408 |
Phone Number: | 5304684470 |
Fax Number: | 5304684478 |
NPI Enumeration Date: | 02/05/2007 |
NPI Last Update Date: | 08/15/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA14029 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |