Healthcare Provider Details

I. General information

NPI: 1396713434
Provider Name (Legal Business Name): MARK CLIFFORD GOODWIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36977 PARK AVE
BURNEY CA
96013-4067
US

IV. Provider business mailing address

36977 PARK AVE
BURNEY CA
96013-4067
US

V. Phone/Fax

Practice location:
  • Phone: 530-335-3651
  • Fax: 530-335-3632
Mailing address:
  • Phone: 530-335-3651
  • Fax: 530-335-3632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA70773
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: