Provider Demographics
NPI:1689888034
Name:HISGHMAN, JONATHAN GOODWIN II (DO)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:GOODWIN
Last Name:HISGHMAN
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 STATE ROAD 54
Mailing Address - Street 2:ANESTHESIA DEPT
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655
Mailing Address - Country:US
Mailing Address - Phone:727-834-4095
Mailing Address - Fax:
Practice Address - Street 1:9440 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655
Practice Address - Country:US
Practice Address - Phone:727-848-1733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCOS9623207L00000X
FLOS0009623207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0S9623OtherMEDICAL LISCENSE