Provider Demographics
NPI:1821255852
Name:GOODWIN, PENNY LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:PENNY
Middle Name:LYNN
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 SAM HOUSTON JONES PKWY
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70611-5603
Mailing Address - Country:US
Mailing Address - Phone:337-855-3438
Mailing Address - Fax:337-855-9488
Practice Address - Street 1:237 SAM HOUSTON JONES PKWY
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70611-5603
Practice Address - Country:US
Practice Address - Phone:337-855-3438
Practice Address - Fax:337-855-9488
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD026396207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine