Provider Demographics
NPI:1841407301
Name:GOODWIN, MATTHEW D (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:D
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 1:7280 W PALMETTO PARK RD STE 305
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3401
Mailing Address - Country:US
Mailing Address - Phone:561-393-8800
Mailing Address - Fax:561-393-6202
Practice Address - Street 1:7280 W PALMETTO PARK RD STE 305
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3401
Practice Address - Country:US
Practice Address - Phone:561-393-8800
Practice Address - Fax:561-393-6202
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97906174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
38257OtherBCBS GROUP NUMBER
AI701ZOtherMEDICARE PTAN
16548OtherBCBS NON-PAR #