Healthcare Provider Details

I. General information

NPI: 1710947718
Provider Name (Legal Business Name): STEPHANIE GOODWIN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR EVANS ARMY COMMUNITY HOSPITAL
COLORADO SPRINGS CO
80913-4613
US

IV. Provider business mailing address

420 OXFORD LN
WOODLAND PARK CO
80863-9464
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7111
  • Fax: 719-526-4090
Mailing address:
  • Phone: 719-200-7024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number45819
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: