Provider Demographics
NPI:1891854329
Name:GOODWIN, DONALD (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 ANCHORAGE DRIVE SOUTH
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-5024
Mailing Address - Country:US
Mailing Address - Phone:561-848-5288
Mailing Address - Fax:561-842-6899
Practice Address - Street 1:733 US HIGHWAY 1
Practice Address - Street 2:BLDG 2B
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-4513
Practice Address - Country:US
Practice Address - Phone:561-841-8588
Practice Address - Fax:561-841-8533
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME343722085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN272625OtherWELLCARE
FLN272625OtherSOUTH FLORIDA REGION HEALTHEASE
FLN272625OtherSTAYWELL HEALTH PLAN
FL054675500Medicaid
FL300054216OtherRAILROAD MEDICARE
FLN272625OtherHEALTHEASE HEALTHPLAN
FL50933OtherBCBS
FL990105OtherNEIGHBORHOOD HEALTH
FLN272625OtherSOUTH FLORIDA REGION HEALTHEASE
FL300054216OtherRAILROAD MEDICARE