Healthcare Provider Details

I. General information

NPI: 1417934092
Provider Name (Legal Business Name): CARL V GOODIN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5315 DELHI AVE
CINCINNATI OH
45238-5214
US

IV. Provider business mailing address

4700 SMITH RD SUITE A
CINCINNATI OH
45212-2787
US

V. Phone/Fax

Practice location:
  • Phone: 513-251-4753
  • Fax: 513-251-4788
Mailing address:
  • Phone: 513-533-1199
  • Fax: 513-533-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36002063
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: