Provider Demographics
NPI:1063507184
Name:GOODIN, DOUGLAS SPROUL
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:SPROUL
Last Name:GOODIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 PARNASSUS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRAQNCISOCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117
Mailing Address - Country:US
Mailing Address - Phone:415-514-2464
Mailing Address - Fax:415-514-2443
Practice Address - Street 1:1500 OWENS ST STE 320
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2335
Practice Address - Country:US
Practice Address - Phone:415-353-2069
Practice Address - Fax:415-353-2633
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG404442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology