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General NPI Number Information
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NPI Number | 1619260395
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Entity Type | Organization
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Legal Business Name | GOODWIN MEDICAL GROUP, PLLC
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Dates
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Enumeration Date | 05/27/2011
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Last Update Date | 08/03/2011
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Provider Practice Location Address
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Address Line | 2020 SOUTH SERVICE RD
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City | MOORE
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State | OK
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Zip | 73160
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Country | US
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Telephone | 405-250-8441
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Fax |
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Provider Business Mailing Address
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Address Line | 9750 CHLOE LN
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City | NORMAN
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State | OK
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Zip | 73026-7008
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Country | US
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Telephone | 405-250-8441
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROGER B. YOUNG II
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Credential | M.D.
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Telephone | 405-250-8441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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