Healthcare Provider Details

I. General information

NPI: 1275851792
Provider Name (Legal Business Name): JOSHUA JAMES GOODWIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N GREEN VALLEY PKWY STE 325
HENDERSON NV
89074-6393
US

IV. Provider business mailing address

100 N GREEN VALLEY PKWY STE 325
HENDERSON NV
89074-6393
US

V. Phone/Fax

Practice location:
  • Phone: 702-722-6030
  • Fax: 702-776-7138
Mailing address:
  • Phone: 702-722-6030
  • Fax: 702-776-7138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number17729
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number48628
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number48628
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number42982
License Number StateIA
# 5
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number17729
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: