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NPI Code Detail

MEDICARE: DR. TIMOTHY ALWYN GOODEN MD

MEDICARE:  DR. TIMOTHY ALWYN GOODEN  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
1207QA0401XAddiction Medicine (Family Medicine) PhysicianME 114669FL

General Provider Information

NPI Number : 1932289154
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIMOTHY ALWYN GOODEN MD
Provider Business Mailing Address
First Line : 2068 HEALTH CARE AVE
Second Line :
City : NAVARRE
State : FL
Zip : 32566-2901
Country : US
Telephone Number : 850-939-1200
Fax Number : 850-939-1257
Provider Business Practice Location Address
First Line : 2068 HEALTH CARE AVE
Second Line :
City : NAVARRE
State : FL
Zip : 32566-2901
Country : US
Telephone Number : 850-939-1200
Fax Number : 850-939-1257
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2006
Last Update Date : 12/15/2012

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Directions to “ DR. TIMOTHY ALWYN GOODEN MD” Practice Location

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