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General NPI Number Information
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NPI Number | 1730340076
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Entity Type | Individual
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Provider Name | ROBERT BROCK GOODWIN D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/19/2008
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Last Update Date | 09/07/2010
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Provider Practice Location Address
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Address Line | 6161 S YALE AVE
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City | TULSA
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State | OK
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Zip | 74136-1902
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Country | US
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Telephone | 918-494-1805
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Fax |
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Provider Business Mailing Address
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Address Line | 6600 S YALE AVE SUITE 1400
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City | TULSA
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State | OK
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Zip | 74136-3347
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Country | US
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Telephone | 918-488-6001
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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 | 150288
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 2008-01264
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License Number State | NC
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