Provider Demographics
NPI:1285672345
Name:GOODWIN, ANIKA S (MD)
Entity Type:Individual
Prefix:
First Name:ANIKA
Middle Name:S
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANIKA
Other - Middle Name:GOODWIN
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1846 E INNOVATION PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-1963
Mailing Address - Country:US
Mailing Address - Phone:833-746-5393
Mailing Address - Fax:
Practice Address - Street 1:1846 E INNOVATION PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-1963
Practice Address - Country:US
Practice Address - Phone:833-746-5393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
FLME136686207W00000X
GA057437207W00000X, 208200000X
SCTL32880207W00000X, 208200000X
UT10915237-1205207W00000X
AZ56691207W00000X
AL37377207W00000X
NE31097207W00000X
IAMD45562207W00000X
COCDR.0000195207W00000X
WY11747C207W00000X
NC2014-00564208200000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA53092326OtherMEDICARE PTAN
GA938942945BMedicaid
SC328808Medicaid
GA938942945AMedicaid
GA938942945CMedicaid
GA18BDGPZMedicare PIN
GA938942945AMedicaid