Healthcare Provider Details

I. General information

NPI: 1053472704
Provider Name (Legal Business Name): WENDY E. GOODWIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 HARRY HINES BLVD DEPT. OF PHYSICAL MEDICINE & REHABILITATION
DALLAS TX
75390-7201
US

IV. Provider business mailing address

5323 HARRY HINES BLVD DEPT. OF PHYSICAL MEDICINE & REHABILITATION
DALLAS TX
75390-7201
US

V. Phone/Fax

Practice location:
  • Phone: 214-648-2733
  • Fax:
Mailing address:
  • Phone: 214-648-2733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberM5191
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: