Healthcare Provider Details

I. General information

NPI: 1285672345
Provider Name (Legal Business Name): ANIKA S. GOODWIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANIKA GOODWIN BRADLEY MD

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 09/08/2024
Certification Date: 09/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 W CAMINO REAL STE 1180
BOCA RATON FL
33432-5942
US

IV. Provider business mailing address

160 W CAMINO REAL STE 1180
BOCA RATON FL
33432-5942
US

V. Phone/Fax

Practice location:
  • Phone: 336-705-0516
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberCDR.0000195
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number31097
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD45562
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number10915237-1205
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number37377
License Number StateAL
# 6
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number11747C
License Number StateWY
# 7
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME136686
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number057437
License Number StateGA
# 9
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 10
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberTL32880
License Number StateSC
# 11
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2014-00564
License Number StateNC
# 12
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number56691
License Number StateAZ
# 13
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number2014-00564
License Number StateNC
# 14
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number057437
License Number StateGA
# 15
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberTL32880
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: