Healthcare Provider Details

I. General information

NPI: 1457385924
Provider Name (Legal Business Name): MEREDITH ANN GOODWIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 04/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 HOSPITAL WAY BLDG 650
MATHER CA
95655-4200
US

IV. Provider business mailing address

1115 W CALL ST DEPT. FAMILY MEDICINE/RURAL HEALTH, FSU COLL OF MEDICIN
TALLAHASSEE FL
32304-3556
US

V. Phone/Fax

Practice location:
  • Phone: 916-843-7000
  • Fax:
Mailing address:
  • Phone: 850-644-9454
  • Fax: 850-645-2859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG064592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: