Provider Demographics
NPI:1932289154
Name:GOODEN, TIMOTHY ALWYN (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ALWYN
Last Name:GOODEN
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 1:2068 HEALTH CARE AVE
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-2901
Mailing Address - Country:US
Mailing Address - Phone:850-939-1200
Mailing Address - Fax:850-939-1257
Practice Address - Street 1:2068 HEALTH CARE AVE
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-2901
Practice Address - Country:US
Practice Address - Phone:850-939-1200
Practice Address - Fax:850-939-1257
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2012-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 114669207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine