MEDICARE: THOMAS 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	207VM0101X	Maternal & Fetal Medicine Physician	G65953	CA
2	207VX0000X	Obstetrics Physician	G65953	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
2	00G659530	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1770588899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS M GOODWIN M.D.

Provider Business Mailing Address
First Line	:	1640 MARENGO ST
Second Line	:	STE 505
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1038
Country	:	US
Telephone Number	:	323-221-3270
Fax Number	:	323-225-6284

Provider Business Practice Location Address
First Line	:	1400 S GRAND AVE
Second Line	:	STE 805
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3011
Country	:	US
Telephone Number	:	213-763-1500
Fax Number	:	213-763-1505

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	08/22/2007

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Directions to “ THOMAS M GOODWIN M.D.” Practice Location

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