MEDICARE: DR. JEAN M. 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	102L00000X	Psychoanalyst	J3945	TX
2	2084P0015X	Psychosomatic Medicine Physician	J3945	TX

General Provider Information

NPI Number	:	1700909645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN M. GOODWIN M.D.

Provider Business Mailing Address
First Line	:	4925 FORT CROCKETT BLVD
Second Line	:	SUITE 510
City	:	GALVESTON
State	:	TX
Zip	:	77551-6003
Country	:	US
Telephone Number	:	409-762-1101
Fax Number	:	409-762-1163

Provider Business Practice Location Address
First Line	:	4925 FORT CROCKETT BLVD
Second Line	:	SUITE 510
City	:	GALVESTON
State	:	TX
Zip	:	77551-6003
Country	:	US
Telephone Number	:	409-762-1101
Fax Number	:	409-762-1163

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

Provider Enumeration Date	:	04/07/2007
Last Update Date	:	09/11/2025

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Directions to “ DR. JEAN M. GOODWIN M.D.” Practice Location

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