Provider Demographics
NPI:1841411949
Name:GOODWIN, HOWARD BRUCE (PA-C)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:BRUCE
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 NE ST JOHNS RD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-2573
Mailing Address - Country:US
Mailing Address - Phone:360-695-9922
Mailing Address - Fax:360-695-1310
Practice Address - Street 1:4421 NE ST JOHNS RD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-2573
Practice Address - Country:US
Practice Address - Phone:360-695-9922
Practice Address - Fax:360-695-1310
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA0000198363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant