MEDICARE: MRS. GLENDA DARLENE GOODWIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	A71660	CA
2	207QS0010X	Sports Medicine (Family Medicine) Physician	A71660	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184685141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GLENDA DARLENE GOODWIN M.D.

Provider Business Mailing Address
First Line	:	1106 WINDFIELD WAY
Second Line	:	SUITE 2
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-9360
Country	:	US
Telephone Number	:	916-941-6500
Fax Number	:	916-691-4300

Provider Business Practice Location Address
First Line	:	1106 WINDFIELD WAY
Second Line	:	SUITE 2
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-9360
Country	:	US
Telephone Number	:	916-941-6500
Fax Number	:	916-691-4300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2006
Last Update Date	:	04/19/2013

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