Provider Demographics
NPI:1578586814
Name:GOODIN, WILLIAM HARVICE (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HARVICE
Last Name:GOODIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 W PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3270
Mailing Address - Country:US
Mailing Address - Phone:559-781-1665
Mailing Address - Fax:559-781-6036
Practice Address - Street 1:585 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3270
Practice Address - Country:US
Practice Address - Phone:559-781-1665
Practice Address - Fax:559-781-6036
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC39402207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA37138Medicare UPIN
CA00C394020Medicare PIN