MEDICARE: STEPHEN GOODWIN MD

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	207Y00000X	Otolaryngology Physician	015145	LA

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	:	1548251101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN GOODWIN MD

Provider Business Mailing Address
First Line	:	120 MEADOWCREST ST
Second Line	:	SUITE 200
City	:	GRETNA
State	:	LA
Zip	:	70056-5255
Country	:	US
Telephone Number	:	504-391-7650
Fax Number	:	504-394-7344

Provider Business Practice Location Address
First Line	:	120 MEADOWCREST ST
Second Line	:	SUITE 200
City	:	GRETNA
State	:	LA
Zip	:	70056-5255
Country	:	US
Telephone Number	:	504-391-7650
Fax Number	:	504-394-7344

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	09/11/2008

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Directions to “ STEPHEN GOODWIN MD” Practice Location

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