Provider Demographics
NPI:1730478611
Name:GOODWIN, BRANDON PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:PATRICK
Last Name:GOODWIN
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:PO BOX 650859, DEPT 710
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0859
Mailing Address - Country:US
Mailing Address - Phone:409-772-2222
Mailing Address - Fax:
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:DEPARTMENT OF DERMATOLOGY
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0783
Practice Address - Country:US
Practice Address - Phone:409-772-1911
Practice Address - Fax:409-772-1943
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0447207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology