Provider Demographics
NPI:1649208851
Name:GOODWIN, THOMAS EARL (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EARL
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 190930
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-0930
Mailing Address - Country:US
Mailing Address - Phone:208-367-5170
Mailing Address - Fax:208-367-5180
Practice Address - Street 1:3025 W CHERRY LN STE 205
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8530
Practice Address - Country:US
Practice Address - Phone:208-302-3500
Practice Address - Fax:208-302-3555
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2024-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDM5214207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC36975Medicare UPIN