Provider Demographics
NPI:1366838666
Name:GOODWYN, PAUL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:GOODWYN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3126 N CIVIC CENTER PLZ
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6912
Mailing Address - Country:US
Mailing Address - Phone:480-874-2040
Mailing Address - Fax:480-874-2041
Practice Address - Street 1:3126 N CIVIC CENTER PLZ
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6912
Practice Address - Country:US
Practice Address - Phone:480-874-2040
Practice Address - Fax:480-874-2041
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ59331207X00000X
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery