Healthcare Provider Details

I. General information

NPI: 1851350052
Provider Name (Legal Business Name): MAX H GOODWIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 BRANSON LANDING BLVD STE. 100
BRANSON MO
65616-4500
US

IV. Provider business mailing address

545 BRANSON LANDING BLVD STE. 100
BRANSON MO
65616-4500
US

V. Phone/Fax

Practice location:
  • Phone: 417-335-7555
  • Fax:
Mailing address:
  • Phone: 417-335-7555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31623
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2009017627
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: