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General NPI Number Information
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NPI Number | 1699206805
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Entity Type | Individual
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Provider Name | ZACHARY-ROSS DAVID GOODWIN M.D
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Gender | Male
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Dates
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Enumeration Date | 03/21/2017
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 64301 HIGHWAY 434
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City | LACOMBE
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State | LA
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Zip | 70445-5411
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Country | US
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Telephone | 985-885-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 64301 HIGHWAY 434
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City | LACOMBE
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State | LA
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Zip | 70445-5411
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Country | US
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Telephone | 985-882-4500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 331359
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License Number State | LA
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