Provider Demographics
NPI:1346273166
Name:STEVEN E GOODWILLER MD PA
Entity Type:Organization
Organization Name:STEVEN E GOODWILLER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:EVERETT
Authorized Official - Last Name:GOODWILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-763-6179
Mailing Address - Street 1:402 W 19TH STREET
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4651
Mailing Address - Country:US
Mailing Address - Phone:850-763-6179
Mailing Address - Fax:850-763-0412
Practice Address - Street 1:402 W 19TH STREET
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4651
Practice Address - Country:US
Practice Address - Phone:850-763-6179
Practice Address - Fax:850-763-0412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050344207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1353Medicare ID - Type Unspecified
FL0560700001Medicare NSC