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NPI Code Detail

MEDICARE: RODNEY P GOODWIN PHD

MEDICARE: RODNEY P GOODWIN PHD
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
1103TC0700XClinical Psychologist0218PAR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15X195OTHERARBLUE CROSS
2302410OTHERARMHN PROVIDER NUMBER

General Provider Information

NPI Number : 1356313670
Entity Type Code : Individual
Provider Name (Legal Business Name) : RODNEY P GOODWIN PHD
Provider Business Mailing Address
First Line : 715 N COLLEGE AVE
Second Line :
City : EL DORADO
State : AR
Zip : 71730-4403
Country : US
Telephone Number : 870-862-7921
Fax Number : 870-864-2490
Provider Business Practice Location Address
First Line : 715 N COLLEGE AVE
Second Line :
City : EL DORADO
State : AR
Zip : 71730-4403
Country : US
Telephone Number : 870-862-7921
Fax Number : 870-864-2490
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2006
Last Update Date : 07/08/2007

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Directions to “ RODNEY P GOODWIN PHD” Practice Location

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