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NPI Code Detail

MEDICARE: DR. GREGORY R GOODWIN DO

MEDICARE: DR. GREGORY R GOODWIN DO
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
1207P00000XEmergency Medicine Physician102077MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2431767432OTHERMOTRICARE

General Provider Information

NPI Number : 1689780744
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY R GOODWIN DO
Provider Business Mailing Address
First Line : 100 HOSPITAL DR
Second Line :
City : LEBANON
State : MO
Zip : 65536-9210
Country : US
Telephone Number : 417-533-6100
Fax Number :
Provider Business Practice Location Address
First Line : 100 HOSPITAL DR
Second Line :
City : LEBANON
State : MO
Zip : 65536-9210
Country : US
Telephone Number : 417-533-6100
Fax Number : 417-533-6173
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2006
Last Update Date : 08/05/2015

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