Provider Demographics
NPI:1902842347
Name:GOODWIN, ROBERT SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:SCOTT
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 1:2000A SOUTHBRIDGE PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7718
Mailing Address - Country:US
Mailing Address - Phone:205-871-4274
Mailing Address - Fax:205-871-4301
Practice Address - Street 1:800 MONTCLAIR RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1908
Practice Address - Country:US
Practice Address - Phone:205-871-4274
Practice Address - Fax:205-871-4301
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000211452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL169817Medicaid
AL105465Medicaid
AL515-91847OtherBLUE CROSS
AL511-09729OtherBLUE CROSS
AL515-91850OtherBLUE CROSS
AL515-94531OtherBLUE CROSS
AL103118Medicaid
AL511-56295OtherBLUE CROSS
AL122536Medicaid
AL103122Medicaid
AL103118Medicaid
AL515-91847OtherBLUE CROSS
AL102I309193Medicare PIN