Provider Demographics
NPI:1649207218
Name:GOODIN, ROBERT R (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
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 1:2171 PINE RIDGE RD
Mailing Address - Street 2:STE F
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-2002
Mailing Address - Country:US
Mailing Address - Phone:239-566-7425
Mailing Address - Fax:239-593-3430
Practice Address - Street 1:2171 PINE RIDGE RD
Practice Address - Street 2:STE F
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2002
Practice Address - Country:US
Practice Address - Phone:239-566-7425
Practice Address - Fax:239-593-3430
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLL678207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100388770AMedicaid
IN100388770FMedicaid
KY64139041Medicaid
KYC68486Medicare UPIN
IN100388770AMedicaid
KY0558205Medicare PIN
KY0259802Medicare PIN
KY0558503Medicare PIN
FLCM836ZMedicare PIN
KY00059002Medicare PIN
KY64139041Medicaid
KY060049834Medicare PIN
IN100388770FMedicaid
FL77169AMedicare PIN